Polyomavirus Reactivation in Pediatric Patients with Systemic Lupus Erythematosus

Rianthavorn, Pornpimol; Posuwan, Nawarat; Payungporn, Sunchai; Theamboonlers, Apiradee; Poovorawan, Yong

doi:10.1620/tjem.228.197

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…This finding highlights the importance of checking both the urine and blood for BK virus infection and raises the question of BK virus tissue tropism. The BK viruria and/or viremia was transient and and the clinical findings of proteinuria, hematuria or elevated serum creatinine levels did not strongly support infection, which is similar to findings noted by Colla et al [18], Lu et al [19], and Rainthavorn et al [20]. We did not find a relationship between the incidence of thrombocytopenia and BK virus as reported by Lu et al [13].…”

Section: Discussionsupporting

confidence: 85%

BK viruria and viremia in children with systemic lupus erythematosus

et al. 2017

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BackgroundBK virus (BKV) is a ubiquitous polyoma virus that lies dormant in the genitourinary tract once acquired in early childhood. In states of cellular immunodeficiency, the virus can reactivate to cause hemorrhagic cystitis and nephritis. Children with systemic lupus erythematosus (SLE) have an increased risk of developing infectious complications secondary to their immunocompromised state from the administration of several immuno-modulatory drugs. Currently, there are no data regarding the prevalence of BK viruria or viremia in children with SLE.MethodsWe conducted a prospective cohort study involving children with SLE of 18 years and younger. We obtained urine and blood samples at baseline and every 3 months up to 1 year for BK virus detection by real-time, quantitative polymerase chain reaction analysis. A comprehensive review of demographic information, clinical characteristics and medication history was also obtained.ResultsThirty-two pediatric patients (26 females and 6 males) with SLE were enrolled. Median age at the time of SLE diagnosis and enrollment into study was 13.6 years and 16.0 years old, respectively. The prevalence at enrollment was 3.1% (1/32) for BK viruria and 6.2% (2/32) for BK viremia. During the study period, 3 patients had viruria, 5 had viremia and 4 had both viruria and viremia. Of the 12 patients with BKV reactivation, only one was positive for microscopic hematuria, all others were asymptomatic. A total of nine of 97(9.2%) urine samples and 10 of 96(10.4%) blood samples were positive for BK virus. The most commonly utilized biologics in this cohort group were Rituximab (90.6%), Abatacept (12.5%), and Belimumab (9.3%). The type of medication exposure and clinical characteristics did not statistically differ between the groups that did or did not have BK viruria and/or viremia.ConclusionsOur study suggests that pediatric patients with SLE have BK viremia and/or viruria at a higher rate than the general healthy population, although the significance of the reactivation and viral level is unclear. The influence of immune-modulatory drugs on BKV reactivation is still uncertain. To understand the interplay amongst BK virus, immunosuppression and dysregulated immune system in children with SLE, ongoing research in a larger population is still warranted, which may help establish proper surveillance, diagnosis and treatment for BKV infection.

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Section: Discussionsupporting

confidence: 85%

BK viruria and viremia in children with systemic lupus erythematosus

et al. 2017

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“…Interestingly, patients with positive BKV viruria exhibited a higher incidence of thrombocytopenia and higher complement C3 levels [ 55 ]. Rainthavorn et al [ 56 ] reported that the prevalence of JCV and BKV reactivation was higher in pediatric SLE patients that in the general population. The study reported asymptomatic BKV viruria in 32 % of children with non-active SLE.…”

Section: Reviewmentioning

confidence: 99%

Review article: BK virus in systemic lupus erythematosus

et al. 2015

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BK virus (BKV) is a human polyomavirus with a seroprevalence of 60–80 % in the general population. In renal transplant patients, it is known to cause renal failure, ureteric stenosis and hemorrhagic cystitis. In bone marrow transplant patients, it is evident that BKV can also cause hemorrhagic cystitis along with BK virus nephropathy (BKVN) in the native kidneys, with subsequent renal failure. However, little is known about BVKN in non-transplanted immune-compromised patients, such as systemic lupus erythematosus (SLE) who may have underlying nephritis and have a compromised immune system due to therapy and/or systemic illness. Thus, this article will focus on the clinical aspects of BKV and its association in patients with SLE.

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“…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%).…”

Section: Resultsmentioning

confidence: 99%

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

Merhametsiz¹,

Yıldırım²,

Oğuz³

et al. 2016

Turk Neph Dial Transpl

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OBJeCtIVe: Although BK virus nephropathy (BKVN) has mostly been reported to occur in transplanted kidneys, there has been a gradual increase in cases of BKVN in the native kidney. This study was directed towards investigating the incidence of BKVN in patients undergoing renal biopsy due to acute kidney injury (AKI) who were also immunosuppressed due to a condition other than organ transplantation. MAterIAl and MethOds:Out of the 1223 patients undergoing renal biopsy for various conditions between January 2001 and January 2013, 52 patients who underwent a biopsy for AKI and were immunosuppressed at the time of the biopsy were included into the study. After renal biopsies of all patients were reevaluated, all biopsy specimens were exposed to immunohistochemical staining for SV40 antibody. results:Of the 52 patients, 29 had primary glomerulonephritis, 18 had secondary glomerulonephritis and 5 had a malignancy. All patients except one case of acute lymphoblastic leukemia and one case of non-Hodgkin lymphoma were immunosuppressed due to immunosuppressive therapy. None of the patients had any signs of BKVN on immunohistochemical staining of renal biopsy specimens.COnClusIOn: Failure to detect BKVN in this study may be because BKV causes gradual impairment of renal functions and the sample did not include patients frequently observed to have BKVN in the native kidney.keY wOrds: Acute kidney injury, BK virus nephropathy, Immunosuppression, Renal biopsy, Renal transplantation, SV40 antibody Öz AMAÇ: BK virüs nefropatisi (BKVN) çoğunluğu böbrek nakli olgularında tanımlansa da, öz böbreklerde de giderek artan oranda BKVN olguları tanımlanmaktadır. Çalışmada, akut böbrek yetmezliği nedeniyle böbrek biyopsisi yapılan organ nakli dışında bir nedene bağlı immünsüpresif hastaların renal biyopsi örneklerinde BKVN sıklığını araştırmayı amaçladık. GereÇ ve YÖnteMler:Ocak 2001-Ocak 2013 tarihleri arasında çeşitli nedenlerle böbrek biyopsisi yapılmış 1223 hastadan akut böbrek hasarı nedeniyle biyopsi yapılmış ve biyopsi esnasında immünsüpresif olup çalışmaya uygun olan 52 hasta çalışmaya dahil edildi. Çalışmaya alınan hastaların böbrek biyopsileri tekrar değerlendirilerek ışık mikroskopisinde BKV'ye ait olabilecek değişiklikler arandıktan sonra tüm biyopsi materyallerine SV40 immünhistokimyasal antikor boyaması yapıldı.BulGulAr: Olguların tanısal dağılımı şu şekildeydi; 29 hasta primer glomerülonefrit (GN), 18 hasta sekonder GN ve 5 hasta malignite. Hastaların ikisi (ALL ve NHL olguları) hariç hepsi immünsüpresif tedavi nedeniyle immünsüpresiftiler. Böbrek biyopsilerinde yapılan immün histokimyasal boyamada 52 olgunun hiçbirinde BKVN'ye ait bulguya rastlanmadı ve tüm olgularda SV40 negatif saptandı.sOnuÇ: Sonuç olarak çalışmamızda, akut böbrek hasarı nedeniyle böbrek biyopsisi yapılmış olgularda BKVN'yi saptayamamış olmamız, BKVN'nin böbrek fonksiyonlarında yavaş seyirli bir bozulmaya sebep olmasından veya bu çalışmanın BKV'nin öz böbrek nefropatisinin daha çok izlendiği hastaları içermemesinden kaynaklanmış olabilir.

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Polyomavirus Reactivation in Pediatric Patients with Systemic Lupus Erythematosus

Cited by 14 publications

References 32 publications

BK viruria and viremia in children with systemic lupus erythematosus

BK viruria and viremia in children with systemic lupus erythematosus

Review article: BK virus in systemic lupus erythematosus

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

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