Polyomavirus infection in kidney transplantation

Abstract

Transplantation centers often deal with opportunistic infections in immunocompromised patients. Besides the morbimortality associated to them, specific technologies are necessary to define their diagnosis. Polyomavirus family has a high prevalence in a latent form in the renal parenchyma among the general population, representing a special risk for virus reactivation during the immunossupression in kidney transplant recipients. BKV infection is associated to ureteral stenosis, causing obstructive uropathy or a specific renal dysfunction, known as BKV Nephropathy (BKN). This last entity is characterized as a progressive decrease of the renal function up to reaching the graft loss, frequently misdiagnosed as a rejection. Clinical suspection and the potential for a specific viral diagnosis is crucial to set the therapeutic and the prognostic. The knowledge concerning the Polyomavirus biology, its physiopathological role and the efficacy of several available diagnostic tools help to define the better strategy to the early viral disease diagnosis and its monitorization under specific therapies. This paper describes a rationale for clinical investigation in high risk patients for BKN, discussing each laboratory test in a hierarchical way, based on their sensitivity, specificity and complexity.