BK virus: Difference between revisions
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** Occasional hematuria and fever |
** Occasional hematuria and fever |
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| − | ===Ureteral |
+ | ===[[Ureteral Stenosis]]=== |
* Causes urinary obstruction and AKI in the donor kidney, usually without pain since it is not innervated |
* Causes urinary obstruction and AKI in the donor kidney, usually without pain since it is not innervated |
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| − | ===Hemorrhagic cystitis=== |
+ | ===[[Hemorrhagic cystitis|Hemorrhagic Cystitis]]=== |
* Complicates 10 to 25% of [[hematopoietic stem cell transplantation]]s, most commonly in the context of [[GVHD]] |
* Complicates 10 to 25% of [[hematopoietic stem cell transplantation]]s, most commonly in the context of [[GVHD]] |
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| − | * Symptoms include hematuria, dysuria, urinary urgency and frequency, and suprapubic pain |
+ | * Symptoms include [[hematuria]], dysuria, urinary urgency and frequency, and suprapubic pain |
* Clotting hematuria can cause urinary obstruction and renal failure |
* Clotting hematuria can cause urinary obstruction and renal failure |
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| − | ===Other |
+ | ===Other Syndromes=== |
| − | * Very rarely causes encephalitis and pneumonitis |
+ | * Very rarely causes [[encephalitis]] and [[pneumonitis]] |
==Diagnosis== |
==Diagnosis== |
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Revision as of 13:12, 15 February 2022
Background
Microbiology
- Double-stranded DNA virus in the Polyomaviridae family
Epidemiology
- Very high seroprevalence with asymptomatic infection ocurring in childhood
- Disease is seen in immunosuppressed patients, especially renal transplant recipients
- BKV nephropathy is seen in 1 to 10% of renal transplant recipients
- BKV ureteric stenosis is seen in about 3% of renal transplant recipients
- Hemorrhagic cystitis is seen in 10 to 25% of hematopoietic stem cell transplantation recipients
Clinical Manifestations
Nephropathy
- Typically a cause of nephropathy in renal transplant patients
- Onset is 10 to 13 months post-transplant, with a wide range of 6 days to 5 years
- Presents with slowly increasing creatinine levels
- Occasional hematuria and fever
Ureteral Stenosis
- Causes urinary obstruction and AKI in the donor kidney, usually without pain since it is not innervated
Hemorrhagic Cystitis
- Complicates 10 to 25% of hematopoietic stem cell transplantations, most commonly in the context of GVHD
- Symptoms include hematuria, dysuria, urinary urgency and frequency, and suprapubic pain
- Clotting hematuria can cause urinary obstruction and renal failure
Other Syndromes
- Very rarely causes encephalitis and pneumonitis
Diagnosis
- Nephropathy: screening with urine or blood PCR followed by biopsy if concurrent renal dysfunction to confirm the diagnosis
- Hemorrhagic cystitis: urine PCR is relatively non-specific, although a high viral load may be supportive
- Urine cytology may show decoy cells, though they are also seen in CMV and adenovirus
Management
- There is no directed therapy
- Nephropathy is typically managed by decreasing immunosuppression, monitoring viremia for response
- Ureteral stenosis is similarly managed, but may require surgical intervention
- Hemorrhagic cystitis is managed supportively, with continuous bladder irrigation, analgesia, hydration, and transfusion of platelets or erythrocytes as needed
- Target for platelets is >50k
Prevention
- In renal transplant patients, monitor for viremia monthly after transplant, decreasing immunosuppression if positive
