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Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction.

Publication ,  Journal Article
Westervelt, JD; Alexander, BD; Costa, SF; Miller, SE; Howell, DN; Smith, SR
Published in: Clin Transplant
2013

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.

Duke Scholars

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Published In

Clin Transplant

DOI

EISSN

1399-0012

Publication Date

2013

Volume

27

Issue

1

Start / End Page

E42 / E48

Location

Denmark

Related Subject Headings

  • Viral Load
  • Urine
  • Tumor Virus Infections
  • Surgery
  • Retrospective Studies
  • Prognosis
  • Polyomavirus Infections
  • Polymerase Chain Reaction
  • Middle Aged
  • Microscopy, Electron
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Westervelt, J. D., Alexander, B. D., Costa, S. F., Miller, S. E., Howell, D. N., & Smith, S. R. (2013). Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction. Clin Transplant, 27(1), E42–E48. https://doi.org/10.1111/ctr.12048
Westervelt, Justin D., Barbara D. Alexander, Sylvia F. Costa, Sara E. Miller, David N. Howell, and Stephen R. Smith. “Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction.Clin Transplant 27, no. 1 (2013): E42–48. https://doi.org/10.1111/ctr.12048.
Westervelt JD, Alexander BD, Costa SF, Miller SE, Howell DN, Smith SR. Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction. Clin Transplant. 2013;27(1):E42–8.
Westervelt, Justin D., et al. “Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction.Clin Transplant, vol. 27, no. 1, 2013, pp. E42–48. Pubmed, doi:10.1111/ctr.12048.
Westervelt JD, Alexander BD, Costa SF, Miller SE, Howell DN, Smith SR. Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction. Clin Transplant. 2013;27(1):E42–E48.
Journal cover image

Published In

Clin Transplant

DOI

EISSN

1399-0012

Publication Date

2013

Volume

27

Issue

1

Start / End Page

E42 / E48

Location

Denmark

Related Subject Headings

  • Viral Load
  • Urine
  • Tumor Virus Infections
  • Surgery
  • Retrospective Studies
  • Prognosis
  • Polyomavirus Infections
  • Polymerase Chain Reaction
  • Middle Aged
  • Microscopy, Electron