Thank you, prof Ahmed for the very comprehensive lecture, use of urine cytology as a screening mode for viruria is still recommended? if you are in the center doing quantitative BKV pcr in blood, this question to all my colleagues
in our center we stopped it many years ago provide we have t regular BKV pcr and we are doing it as first screening test in the first month then every 3 months till 12 months then annual but if we have BKV positive then will monitor it every 2 weeks after IS reduction as per local protocol.
Thank you sir, for the extensive presentation. What I have gathered is that, patients with graft dysfunction should have their blood and urine tested by BKV PCR and managed with reduction of Tacrolimus doses and follow up. Thank you.
Thank prof. for the informative lecture.
The management of co-exiting BKV and AR is still not clear. can we learn from your experience how to deal with such challenging situation
Thank you dr Ahmed, very concised and informative as usual
I want to know if reduction of immunosuppression reduction is done at the same time or sequential?
Does the classes or stages impact the treatment decision? or only for prognostic value?
Thank you, prof, for this valuable presentation Post-transplantation complications, especially viral infections, and diseases are challengeable may I ask about how can we detect BK nephropathy in native kidneys
Thanks Prof Ahmed Halawa for this informative lecture.
is there any difference between kidney affection in the following 2 scenarios:
1- renal transplant recipient who develops BKVN.
2- other organ transplant recipient (heart, lung, liver) who develops BKVN in the native kidney.
Thank you prof Ahmed Halawa for this nice and informative lecture .
regarding occurrence of rejection while managing BKVN we will proceed for management of rejection as per protocol as you said ,but is there any specific recommendation regarding use of antiviral in such a situation.
Thank you Professor Halawa for an excellent lecture
I wanted to inquire about fluoroquinolones generally in post transplant patients. There has been reported high risk of Achilles’ tendon rupture with the use fluoroquinolones in patients who are on chronic steroids.
Although biopsy is the gold standard for diagnosing BKVN, however, the patchy involvement of the tissues and sampling errors can affect the sensitivity of this modality. Ultrasound and color Doppler may aid in this context. See the paper below:
Nephrol. 2017 Jun;30(3):449-453.doi: 10.1007/s40620-016-0327-0.Epub 2016 Jun 24. Ultrasound findings of BK polyomavirus-associated nephropathy in renal transplant patients Mauro Dugo, Margherita Mangino, Mario Meola, Ilaria Petrucci, Maria Luisa Valente, Licia Laurino, Mario Stella, Stefania Mastrosimone, Anna Brunello, Bice Virgilio, Monica Rizzolo, Maria Cristina Maresca Abstract BK polyomavirus (BKV) is an emerging pathogen in immunocompromised patients. BKV infection occurs in 1-9 % of renal transplants and causes chronic nephropathy or graft loss. Diagnosis of BKV-associated nephropathy (BKVAN) is based on detection of viruria then viremia and at least a tubule-interstitial nephritis at renal biopsy. This paper describes the ultrasound and color Doppler (US-CD) features of BKVAN. Seventeen patients affected by BKVAN were studied using a linear bandwidth 7-12 MHz probe. Ultrasound showed a widespread streak-like pattern with alternating normal echoic and hypoechoic streaks with irregular edges from the papilla to the cortex.Renal biopsy performed in hypoechoic areas highlighted the typical viral inclusions in tubular epithelial cells. Our experience suggests a possible role for US-CD in the non-invasive diagnosis of BKVAN when combined with blood and urine screening tests. US-CD must be performed with a high-frequency linear probe to highlight the streak-like pattern of the renal parenchyma.
Thank you, prof, for always delivering a highly enlightening lecture.
My question; is there any cut-off value for PCV testing of BK to diagnose BK viremia in the recipient
Thank you
[A definitive viral load cutoff associated with nephropathy has not been established, but retrospective studies have suggested that a BK viral load >4 log copies/mL is strongly associated with finding BKVN on biopsy].
Reference
Deirdre Sawinski and Simin Goral,BK virus infection: an update on diagnosis and treatment, Nephrol Dial Transplant (2015) 30: 209–217 doi: 10.1093/ndt/gfu023
VERY LUCID PRESENTATION WITH CLEAR APPROACH TO DIAGNOSIS AND TREATMENT
THANKS
Great presentation. Thank you.
thank you, Prof, for such a elaborated and comprehensive lecture.
Thanks DR Ahmed for this amazing and comprehensive lecture
Thank you, prof Ahmed for the very comprehensive lecture, use of urine cytology as a screening mode for viruria is still recommended? if you are in the center doing quantitative BKV pcr in blood, this question to all my colleagues
in our center we stopped it many years ago provide we have t regular BKV pcr and we are doing it as first screening test in the first month then every 3 months till 12 months then annual but if we have BKV positive then will monitor it every 2 weeks after IS reduction as per local protocol.
Comprehensive, as usual. Did not find questions to inquire about. Thanks, Prof. Dr Ahmed
Thank you sir, for the extensive presentation. What I have gathered is that, patients with graft dysfunction should have their blood and urine tested by BKV PCR and managed with reduction of Tacrolimus doses and follow up. Thank you.
Thanks prof Halawa for this informative lecture
Thank prof. for the informative lecture.
The management of co-exiting BKV and AR is still not clear. can we learn from your experience how to deal with such challenging situation
Thank you dr Ahmed, very concised and informative as usual
I want to know if reduction of immunosuppression reduction is done at the same time or sequential?
Does the classes or stages impact the treatment decision? or only for prognostic value?
thank proof. BK virus infection still need more PRCT to reach better approach. To
treatment.
Will reductions percentage be more with stage of BKvirus histology;25% in early and low viremia ,more with TA and IF.
Thanks Prof Ahmed for this informative lecture
Thank you DR.Ahmed for this very informative lecture.
Thank you Professor for the lecture.
My question is regarding the screening for BKV. What is the protocol being followed at your institute? Is it 3 monthly urine PCR for BKV?
Thank you, prof, for this valuable presentation
Post-transplantation complications, especially viral infections, and diseases are challengeable
may I ask about how can we detect BK nephropathy in native kidneys
Thanks Professor Ahmed it is Amazing lecture
thanks Prof for this informative lecture
Thanks so much our Prof. for this elegant and informative lecture.
thanks our prof, very informative wonderful lecture as usual
Thanks Prof for an excellent lecture
Thanks prof for the concise lecture.
Thank you for the precise and informative lecture.
Thank you prof Ahmed for your nice presentation
Many thanks for this informative lecture
Thanks Prof Ahmed Halawa for this informative lecture.
is there any difference between kidney affection in the following 2 scenarios:
1- renal transplant recipient who develops BKVN.
2- other organ transplant recipient (heart, lung, liver) who develops BKVN in the native kidney.
Thank you prof Ahmed Halawa for this nice and informative lecture .
regarding occurrence of rejection while managing BKVN we will proceed for management of rejection as per protocol as you said ,but is there any specific recommendation regarding use of antiviral in such a situation.
Thank you Professor Halawa for an excellent lecture
I wanted to inquire about fluoroquinolones generally in post transplant patients. There has been reported high risk of Achilles’ tendon rupture with the use fluoroquinolones in patients who are on chronic steroids.
Thank you, clear lecture
Thank you for the lecture
Although biopsy is the gold standard for diagnosing BKVN, however, the patchy involvement of the tissues and sampling errors can affect the sensitivity of this modality. Ultrasound and color Doppler may aid in this context.
See the paper below:
Nephrol. 2017 Jun;30(3):449-453. doi: 10.1007/s40620-016-0327-0. Epub 2016 Jun 24.
Ultrasound findings of BK polyomavirus-associated nephropathy in renal transplant patients
Mauro Dugo , Margherita Mangino , Mario Meola , Ilaria Petrucci , Maria Luisa Valente , Licia Laurino , Mario Stella , Stefania Mastrosimone , Anna Brunello , Bice Virgilio , Monica Rizzolo , Maria Cristina Maresca
Abstract
BK polyomavirus (BKV) is an emerging pathogen in immunocompromised patients. BKV infection occurs in 1-9 % of renal transplants and causes chronic nephropathy or graft loss. Diagnosis of BKV-associated nephropathy (BKVAN) is based on detection of viruria then viremia and at least a tubule-interstitial nephritis at renal biopsy. This paper describes the ultrasound and color Doppler (US-CD) features of BKVAN. Seventeen patients affected by BKVAN were studied using a linear bandwidth 7-12 MHz probe. Ultrasound showed a widespread streak-like pattern with alternating normal echoic and hypoechoic streaks with irregular edges from the papilla to the cortex. Renal biopsy performed in hypoechoic areas highlighted the typical viral inclusions in tubular epithelial cells. Our experience suggests a possible role for US-CD in the non-invasive diagnosis of BKVAN when combined with blood and urine screening tests. US-CD must be performed with a high-frequency linear probe to highlight the streak-like pattern of the renal parenchyma.
thank you, very interesting paper
Thank you a lot, Prof Halawa, for the elegant lecture.
Thank you, prof, for always delivering a highly enlightening lecture.
My question; is there any cut-off value for PCV testing of BK to diagnose BK viremia in the recipient
Thank you
[A definitive viral load cutoff associated with nephropathy has not been established, but retrospective studies have suggested that a BK viral load >4 log copies/mL is strongly associated with finding BKVN on biopsy].
Reference
Deirdre Sawinski and Simin Goral, BK virus infection: an update on diagnosis and treatment, Nephrol Dial Transplant (2015) 30: 209–217 doi: 10.1093/ndt/gfu023