Polyomavirus Nephropathy: A Current Perspective and Clinical Considerations

• Published in: American journal of kidney diseases Vol. 54; no. 1; pp. 131 - 142
• Main Author: Wiseman, Alexander C., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2009; Elsevier
• Subjects: Biological and medical sciences; BK virus; BK Virus - pathogenicity; Humans; Immunosuppressive Agents - immunology; Infectious diseases; kidney transplantation; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Medical sciences; Nephritis, Interstitial - epidemiology; Nephritis, Interstitial - virology; Nephrology; Nephrology. Urinary tract diseases; Polyomavirus; Polyomavirus Infections - etiology; review; Risk Factors; Tumor Virus Infections - etiology; Viral diseases; BK virus; review; Polyomavirus; kidney transplantation; Kidney disease; Nephrology; Urinary system disease; Transplantation; Papovaviridae; Review; Kidney; Urology; Infection; Virus; Perspective; Nephropathy; Treatment; Urinary system; Surgery; Viral disease; Graft; Bibliographic review
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2009.01.271

During the last decade, the human polyomaviruses (BK virus and, much less commonly, JC virus) have entered the realm of routine clinical decision making for providers caring for kidney transplant recipients. The emergence of polyomavirus-associated nephropathy (PVAN) as an important clinical entity coincided with the development and use of more potent immunosuppression agents, currently the only clear risk factor for reactivation of the virus. Ongoing efforts to define the pathogenesis, clinical presentation, and appropriate management of PVAN have led to a greater ability to prevent and control viral-induced interstitial nephritis despite continued deficiencies in our understanding of risk factors for disease and lack of published prospective polyomavirus-specific antiviral trials. The purpose of this review is to summarize advances made during the last decade and highlight emerging data that address common clinical considerations the clinician currently faces in the understanding and management of PVAN.