EFFECTIVE STRATEGY FOR THE MANAGEMENT OF BK NEPHROPATHY

 

M.V. Govani*, S. Tata*, C.L. Phillips* +, M.L. Milgrom#

Division of Nephrology* and Departments of Pathology+ and Surgery#, Indiana University Medical Center, Indianapolis, Indiana, USA

 

Background:  Recently, BK nephropathy (BKN) has become an important cause of graft failure in renal transplant recipients concurrent with widespread use of strong immunosuppressive agents (tacrolimus and MMF) and diminishing use of corticosteroids (CS), effective anti-inflammatory agents.  Despite their microbial replication-promoting effect, CS are being used effectively in other infectious diseases along with other measures.  We report 6 cases of BKN managed with increased doses of CS and reduced immunosuppression.

 

Methods:  We retrospectively reviewed the charts of all 6 renal transplant patients with biopsy-proven BKN at our institute.  On diagnosis, they were managed with 1-3 intravenous boluses of methylprednisolone followed by 10-20 mg/day of prednisone (5 mg/day for children <20 kg body weight).  Other immunosupressants were stopped, reduced or changed to less potent agents.  Cidofovir was used in case of poor response after 6 weeks.  Patients were followed closely for renal function (serum creatinine) and viral titers (VIRACOR, Lee’s Summit, MO, USA) in blood and urine.  Mean follow-up was 8.8 + 4.7 (range 4-16) months.

 

Results:  Renal function stabilized in 3 patients. Serum creatinine stabilized at higher levels in the remaining 3 patients who were given cidofovir.  BK virus was eliminated from blood and urine of 2 patients and viral titers dropped significantly in the remaining 4 patients.  No patient developed presumed rejection or graft loss.

Table1.  Demographics, management and outcome in all patients*.

Age

Race

Sex

Donor

IR-PreDx

IR-Post Dx

CR-Base

CR-Dx

CR-Cur

Cid

60y

As

M

CAD

Tac-MMF

Tac-MMF

1.3

1.5

1.5

N

3y

C

M

CAD

Tac-MMF

MMF

0.6

1.2

1.1

N

64y

AA

M

CAD

CsA-MMF

MMF

1.2

1.6

2.4

Y

51y

H

F

LD

Tac-MMF

MMF

1.2

1.7

2.1

Y

10y

AA

M

CAD

Tac-Sir

Aza

0.9

1.2

1.8

Y

48y

C

F

LD

Tac-MMF

Tac-Aza

1.3

1.6

1.5

N

y=years, As=Asian, C=Caucasian, AA=African American, H=Hispanic, IR=Immunosuppressive regimen, CAD=Cadaveric, LD=Living Donor, preDx=Prediagnosis, postDx=Postdiagnosis, Tac=Tacrolimus, MMF=Mycophenolate Mofetil, CsA=Cyclosporine A, Sir=Sirolimus, Aza=Azathioprine, CR=Serum Creatinine, Base=Baseline, Dx=At diagnosis, Cur=Current, Cid=Cidofovir. *  All patients were on CS, in higher dosage after diagnosis.

 

Conclusions:  Effective strategy for BKN may be to use higher dosage of CS along with overall reduction in immunosuppression.  Further studies are necessary to validate our findings.


EFFECTIVE STRATEGY FOR THE MANAGEMENT OF BK NEPHROPATHY

 

 

Correspondence to:

Mahendra V. Govani, MD

Medical Director of Kidney Transplantation

Division of Nephrology

Indiana University Medical Center

550 N. University Blvd., Rm 4620

Indianapolis, IN 46202

Tel:       (317) 274 3721

Fax:      (317) 274 4319

Email    mgovani@iupui.edu

 

 

(Individual submitting and presenting abstract: Carrie Phillips at cphilli3@iupui.edu)