1. Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction.
- Author
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Westervelt JD, Alexander BD, Costa SF, Miller SE, Howell DN, and Smith SR
- Subjects
- Adult, BK Virus genetics, BK Virus isolation & purification, DNA, Viral genetics, Female, Follow-Up Studies, Humans, Male, Microscopy, Electron, Middle Aged, Polymerase Chain Reaction, Polyomavirus Infections blood, Polyomavirus Infections urine, Polyomavirus Infections virology, Prognosis, Retrospective Studies, Tumor Virus Infections blood, Tumor Virus Infections urine, Tumor Virus Infections virology, Urine chemistry, Viral Load, BK Virus ultrastructure, DNA, Viral blood, Kidney Transplantation adverse effects, Polyomavirus Infections diagnosis, Tumor Virus Infections diagnosis, Urine virology
- Abstract
BK polyomavirus (BKV) infection continues to be a significant source of allograft dysfunction in kidney transplant recipients. The optimal screening method to detect BKV remains undetermined. In this retrospective analysis of 347 consecutive kidney transplant recipients, we compare the diagnostic and screening performance of urine electron microscopy (EM) with plasma polymerase chain reaction (PCR) in testing for BKV, using biopsy-proved polyomavirus-associated nephropathy (PVAN) as the gold standard. Sixty-nine of 347 recipients had a positive screening test for BKV infection. Twenty-nine patients underwent biopsy, and 11 were diagnosed with PVAN. Sensitivity rates of urine EM and plasma PCR were 88% and 100%, respectively. Specificity rates of urine EM and plasma PCR were 91% and 78%. There was no statistical difference in the operating characteristics of the two tests. The majority of both plasma PCR and urine EM tests were positive in the six months prior to a diagnostic biopsy confirming PVAN. In those patients who had evidence of BKV infection but did not have PVAN, the percentage of positive screening tests decreased with aggressive lowering of immunosuppression. We conclude that urine EM and plasma PCR both function well in screening for BKV infection and in the diagnosis of PVAN. There is an opportunity to detect viral replication, lower immunosuppression, and to prevent PVAN in this population., (© 2012 John Wiley & Sons A/S.)
- Published
- 2013
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