Open AccessJournal Article
BK-virus nephropathy and simultaneous C4d positive staining in renal allografts.
TLDR
The role of antibodies in rejection of transplanted kidneys was the subject of debate at the last two Banff meetings and in medical journals and diffuse C4d positive staining of peritubular capillaries was recognized as a marker of antibody-mediated rejection and this morphological feature was included in the updated Banff schema.Abstract:
The role of antibodies in rejection of transplanted kidneys was the subject of debate at the last two Banff meetings and in medical journals. Diffuse C4d positive staining of peritubular capillaries (PTCs) was recognized as a marker of antibody-mediated rejection and this morphological feature was included in the updated Banff schema. At the same time polyomavirus infection of the renal allografts has been reported more frequently and is emerging as an important cause of renal allograft dysfunction and graft loss. At the present time, BK-virus nephropathy (BKN) represents the most common viral disease affecting renal allografts. BKN was identified in 6 patients in 12 biopsies and 2 graft nephrectomy specimens of 1115 biopsies between September 2000 and December 2003. Definite virus identification was done by immunohistochemistry. The reason for graft nephrectomies was graft failure due to BKN in a recipient after kidney-pancreas transplantation with good function of his pancreas graft and the necessity of continuing immunosuppression. Detection of C4d deposits was performed by immunofluorescence or by immunohistochemistry. In graftectomy samples C4d detection was performed by immunohistochemistry and retrospectively in all cases of BKN. Focal C4d positive PTCs and BKN were found simultaneously in 9 of 12 needle biopsies and in both graft nephrectomy samples. Detection of C4d by immunohistochemistry disclosed focal C4d positive staining in kidney tissue but diffuse in the sites where BK-virus inclusions in tubular epithelial cells were found. The complement system is part of the host defense response and is crucial to our natural ability to ward off infection. In cases of BKN, virus likely gains access to the bloodstream through injured tubular walls and via PTCs. Vascular endothelium in the PTCs represents a potential target antigen for alloresponse, and simultaneously possibly represents an imprint of complement activation or complement production in the places with BK-virus infection.read more
Citations
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Journal ArticleDOI
The significance of renal C4d staining in patients with BK viruria, viremia, and nephropathy
Ibrahim Batal,Hanady Zainah,Sean Stockhausen,Amit Basu,Henkie P. Tan,Ron Shapiro,Adriana Zeevi,Alin Girnita,Parmjeet Randhawa +8 more
TL;DR: In conclusion, peritubular capillary C4d staining remains a valid marker for the diagnosis of antibody-mediated rejection in the presence of concurrent BK virus infection.
Journal ArticleDOI
Soluble CD30 in patients with antibody-mediated rejection of the kidney allograft.
Antonij Slavcev,Eva Honsova,A. Lodererova,Yelena Pavlova,Helena Sajdlova,Stefan Vitko,Jelena Skibova,I. Striz,Ondrej Viklicky +8 more
TL;DR: It was unable to confirm in this study that high sCD30 levels (>or=100 U/ml) might be predictive for the incidence of HR, but negative s CD30 values might be however helpful for identifying patients with a low risk for development of DSA and antibody-mediated rejection.
Journal ArticleDOI
In kidney transplant recipients with BK polyomavirus infection, early BK nephropathy, microvascular inflammation, and serum creatinine are risk factors for graft loss.
Maha Mohamed,Sandesh Parajuli,Brenda Muth,Brad C. Astor,Sarah E. Panzer,Didier A. Mandelbrot,Weixong Zhong,Arjang Djamali +7 more
TL;DR: Little information is available on the risk factors for graft loss in kidney transplant recipients with BK polyomavirus (BKPyV) nephropathy ( BKVN) in the presence or absence of antibody‐mediated rejection (AMR).
Journal ArticleDOI
Neutrophilic tubulitis as a marker for urinary tract infection in renal allograft biopsies with C4d deposition.
Gaurav Gupta,Ron Shapiro,Alin Girnita,Ibrahim Batal,Jerry McCauley,Amit Basu,Henkie P. Tan,Parmjeet Randhawa +7 more
TL;DR: Neutrophilic tubulitis accompanied by neutrophil clusters in the tubular lumen is a useful marker of UTI, even in the presence of PTC C4d deposition.
Journal ArticleDOI
The case of BK virus infection in which it was difficult to differentiate from acute rejection
Yumi Ito,Shinichi Nishi,Naofumi Imai,Kazuhiro Yoshita,Kazuhide Saito,Yuki Nakagawa,Kota Takahashi,Ichiei Narita +7 more
TL;DR: A case of BK virus infection in which it was difficult to differentiate from acute rejection is presented, in which the immune response to the virus is unclear.
References
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Journal ArticleDOI
Antibody-mediated rejection criteria - an addition to the Banff 97 classification of renal allograft rejection.
Lorraine C. Racusen,Robert B. Colvin,Kim Solez,Michael J. Mihatsch,Philip F. Halloran,Patricia Campbell,Michael Cecka,Jean Pierre Cosyns,Anthony J. Demetris,Michael C. Fishbein,Agnes B. Fogo,Peter N. Furness,Ian W. Gibson,Denis Glotz,Pekka Häyry,Lawrence Hunsickern,Michael Kashgarian,Ronald H. Kerman,Alex J. Magil,Robert A. Montgomery,Kunio Morozumi,Volker Nickeleit,Parmjeet Randhawa,Heinz Regele,Daniel Serón,Surya V. Seshan,Stale Sund,Kiril Trpkov +27 more
TL;DR: This article presents international consensus criteria for and classification of AbAR developed based on discussions held at the Sixth Banff Conference on Allograft Pathology in 2001, to be revisited as additional data accumulate in this important area of renal transplantation.
Journal ArticleDOI
Human polyoma virus-associated interstitial nephritis in the allograft kidney
Parmjeet Randhawa,Sydney D. Finkelstein,Velma P. Scantlebury,Ron Shapiro,Carlos Vivas,Mark L. Jordan,Maria M. Picken,Anthony J. Demetris +7 more
TL;DR: Polyoma virus tubulo-interstitial nephritis-associated graft dysfunction usually calls for judicious decrease in immunosuppression and monitoring for acute rejection, and development of methods to serially quantify the viral load in individual patients could potentially improve clinical outcome.
Journal ArticleDOI
BK-virus nephropathy in renal transplants—tubular necrosis, MHC-class II expression and rejection in a puzzling game
Volker Nickeleit,Hans H. Hirsch,Matthias Zeiler,Fred Gudat,Olivier Prince,Gilbert Thiel,Michael J. Mihatsch +6 more
TL;DR: BK-virus nephropathy is reviewed as a new complication that increasingly affects renal allografts and causes dysfunction and attempts to lower immunosuppression as a means to control viral replication.
Journal ArticleDOI
Banff 2003 meeting report: new diagnostic insights and standards.
TL;DR: The Seventh Banff Conference on Allograft Pathology was held June 14–18, 2003 in Aberdeen, Scotland representing the latest iteration of the international consensus meeting, which develops worldwide standards for interpretation of allograft biopsies.
Journal ArticleDOI
Complement C4d in graft capillaries -- the missing link in the recognition of humoral alloreactivity.
TL;DR: The incidence of C4d‐positive cases will probably decline because of the ‘routine’ application of potent immunosuppressants, including mycophenolate mofetil, that can inhibit antibody production, but Presensitization will remain a potential threat to allografts.