5^th Global Nephrologists Annual Meeting

Biography

Biography: Anupma Kaul

Abstract

Cytomegalovirus (CMV) and BK polyoma virus (BKV) are common infections in which the one acquires infection in childhood which becomes latent. Reactivation of both these viruses can occur in immunosuppressed states, such as renal transplantation, and can rarely result in virus-associated tubulointerstitial nephritis in renal allografts. The clinical picture can mimic, co-exist with or precipitate the rejection process. There is paucity of data comparing outcomes of renal transplant recipients with these viruses. We compared outcomes in patients with renal biopsy proven viral cytopathies. Method and Material: All patients are taken from in patients department of nephrology of a tertiary care teaching hospital in India. All those renal biopsy reports which are reported or suspicious as viral cytopathic changes in kidney were isolated. These biopsies were further examined by two independent renal histopathologist from our institute. They were classified on three groups: CMV viral cytopathic changes, BKV associated viral cytopathic changes and CMV-BKV co-infection associated viral cytopathic changes. Diagnoses were further confirmed with PCR technology in either serum or urine or both. All 20 patients were categorized in 3 groups: 10 in CMV only, 4 in BKV only and 6 were in CMV-BKV co-infection. Results: Out of 20 patients, 16 were male. Mean age is 37.95±11.09 years. Thirteen patients had chronic glomerulonephritis as basic disease, while chronic interstitial nephritis and diabetic nephropathy were basic disease in 2 each. One patient each had Henoch scholein purpura, hypertensive nephropathy and Ig A nephropathy as basic disease. In eight cases, donors 8 were parents (mother in 7 ), 5 were siblings (sister in 3) and 7 spousal ( wife in 5). One patient each had received ATG and Basiliximab as induction while 18 had no induction. All patients received triple drug immunosuppression, 9 received Tacrolimus, mycophenolate and prednisolone, another 9 received Cyclosporine, mycophenolate and prednisolone and 2 patients were started on cyclosporine, Azathioprine and prednisolone. Mean duration of graft survival was 62.70±30.78 months. In CMV subgroup mean graft survival was 65.40±25.25 months while in BKV subgroup was 61±46.46 months and in CMV and BKV co infection mean survival was 59.33±33.56 months. These are statistically not significant. At the end study period 10(50%) died. Conclusion: Cytomegalovirus and BK Virus infection are important infection in post renal transplant recipients. They can result in virus-associated tubulointerstitial nephritis and can mimic, co-exist or precipitate the rejection process. Although their co-infection is not common but they can co-exist. However their co-infection cannot change the graft survival and difference in not significant.