BK Virus Replication in Patients with Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis

Abstract

Background: BK virus (BKV) is an important cause of renal dysfunction in kidney transplant (KTX) recipients. Immunosuppression intensity is a major risk factor for BKV replication in these patients. The prevalence of BKV replication in immunosuppressed patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) without transplant is not known. Methods: Consecutive patients (n = 37) with a diagnosis of GPA (n = 25) or MPA (n = 12) without history of KTX were evaluated for plasma BKV replication by quantitative PCR (group A). Descriptive data were collected. BKV replication in this nontransplant immunosuppressed vasculitis cohort was compared with a historical cohort of vasculitis KTX recipients (group B). Results: Group A patients had mean disease duration of 75 months. Mean age was 57 years and 54% were female. Mean time from vasculitis onset to BKV testing was 36 months, and 19/37 patients were tested within 24 months of induction therapy. At the time of BKV testing, 73% were on prednisone (P) with azathioprine, mycophenolate mofetil (MMF), methotrexate or leflunomide. None of the nontransplanted vasculitis patients had detectable plasma BKV. Among 35 patients in group B, 16 were tested for BKV; 5/16 (31%) had detectable virus in plasma at a mean of 6 months after TX (p = 0.002). Most (94%) were on maintenance therapy with MMF, P and tacrolimus. Conclusion: Immunosuppressed patients with GPA/MPA without KTX had no evidence of plasma BKV. However, BKV was common in GPA/MPA patients after KTX, suggesting that replication may be related to differences in immunosuppression, alloimmune activation or differences in host defense mechanisms.

Evaluation of Renal Biopsies for BK Virus Nephropathy in Non-Renal Transplant Immunosuppressed Patients

“…Patient series with immunosuppression due to a condition other than organ transplantations in which BKV reactivation has been evaluated have SLE (16)(17)(18), ANCA-related vasculitis (19) or multiple sclerosis (20). In a comparative study by Sundsfjord et al (16) on 44 patients with SLE and 88 healthy controls, the rate of BK viruria was significantly higher in the patients with SLE (16% vs. 0%).…”

“…They reported no significant difference in BKV reactivation between the groups and noted that the patients with BKV viruria and viremia had higher levels of urine protein and creatinine and that duration of SLE history was shorter. Geetha et al (19) compared BKV viremia between 37 cases of vasculitis not undergoing renal transplantation and 16 patients undergoing renal transplantation due to vasculitis. The patients ary glomerulonephritis and navelbine, paclitaxel, imatinib, cisplatin, cyclophosphamide, adriamycin and 5-fluorouracil for malignancy.…”

BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

“…A patient under treatment for granulomatosis with polyangiitis developed BK hemorrhagic cystitis[ 169 ]. However, in a series of patients with vasculitis associated with ANCA, only those who had received a kidney transplant exhibited BK viremia[ 170 ]. Manifestations of BKV infection in patients with systemic lupus erythematosus (SLE) include viruria and viremia, and the presence of decoy cells in the urine of a patient with BK viruria, hemorrhagic cystitis and hemophagocytic syndrome[ 171 , 172 ].…”