Title BK-virusom uzrokovana nefropatija Title (english) BK virus-associated nephropathy Author Ana Rukavina Mentor Nikolina Bašić Jukić (mentor)Committee member Željko Kaštelan (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Nikolina Bašić Jukić (član povjerenstva)Granter University of Zagreb Defense date and country 2018-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract UVOD: Suvremena imunosupresivna terapija u bolesnika s transplantiranim bubregom temelji se na primjeni inhibitora kalcijneurina (ICN). U posljednjem desetljeću sve većom primjenom takrolimusa povećala se učestalost disfunkcije presatka uzrokovane BK virusom. Bolesnici sa reaktiviranim BK virusom najčešće imaju asimptomatsku viruriju ili viremiju s ili bez pogoršanja funkcije bubrežnog presatka. ----- CILJ: Glavni cilj ovog istraživanja bio je istražiti učestalost reaktivacije BK virusa u naših bolesnika, pojave BK virusom uzrokovane nefropatije i učinkovitost različitih metoda liječenja. ----- MATERIJALI I METODE: U ovom istraživanju pregledana je medicinska dokumentacija 1960 bolesnika koji se prate u našem transplantacijskom centru. U posljednjih godinu dana u našem se centru radi probir svih novotransplantiranih bolesnika na BK virus, u urinu i krvi 1, 3, 6, 9 i 12 mjeseci nakon transplantacije, a kod ostalih bolesnika BK virurija i viremija se određuje pri svakom pogoršanju funkcije presatka. Izdvojeni su bolesnici kod kojih je dokazan BK virus u krvi i/ili urinu. Retrogradno je praćena promjena imunosupresivne terapije, obzirom na pojavu BK virusa te njena uspješnost. ----- REZULTATI: U 59 bolesnika (78% muškaraca) došlo je do pojave BK virusa u urinu i/ili krvi. Prosječna dob bolesnika bila je 47 godina. Devetnaest bolesnika (32%) imalo je izoliranu viruriju, 10% bolesnika imalo je viremiju, a 58% imalo je i viruriju i viremiju. U trenutku dijagnoze 68% bolesnika liječeno je takrolimusom, a 15% ciklosporinom uz kortikosteroide i mikofenolat mofetil. Bolesnici su liječeni smanjivanjem doza imunosupresiva, uvođenjem ciprofloksacina, prevođenjem takrolimusa u ciklosporin i/ili zamjenom ICN everolimusom. ----- ZAKLJUČAK: Ovim istraživanjem prikazali smo da 3% naših bolesnika ima reaktivaciju BK virusa, a liječeni su različitim terapijskim pristupima. Uvođenjem redovnog modela praćenja reaktivacije BK virusa u naših bolesnika omogućit će se pravovremena terapijska interevencija.
Abstract (english) INTRODUCTION: Modern immunosuppressive therapy in renal transplantation is based on the use of calcineurin inhibitors (CNI). In the last decade, increased use of tacrolimus enhanced the incidence of graft dysfunction caused by BK virus. In most patients, BK reactivation manifests as asymptomatic BK viruria and/or viremia with or without deterioration of graft function. ----- OBJECTIVE: The aim of our study was to investigate the incidence of BK reactivation in our patients, incidence of BK virus-associated nephropathy, and the efficacy of different therapy approaches. ----- MATERIALS AND METHODS: We analyzed the medical records of 1960 patients in our transplant center. In the past year, we started screening all newly transplanted patients for BK virus in blood and urine (B/U) 1, 3, 6, 9, and 12 months after transplantation. In all other cases BK virus (B/U) was assessed if any sign of graft deterioration was found. We selected patients with BK positive blood and/or urine samples, and retrospectively assessed the change in their immunosuppressive therapy regarding BK virus and the efficacy of the intervention. ----- RESULTS: In 59 patients (78% male), BK virus was detected in urine and/or blood. Average patient age was 47 years. Nine patients (32%) had isolated viruria, 10% had viremia and 58% had both viruria and viremia. At the time of diagnosis 68% of the patients received tacrolimus and 15% received cyclosporine with corticosteroids and mycophenolic acid. Different therapy approaches were selected: reduction of the immunosuppressive therapy dose, introduction of ciprofloxacin, conversion of tacrolimus to cyclosporine and/or conversion of CNI to everolimus. ----- CONCLUSION: In this study, we present that 3% of our patients now have a BK virus reactivation which is being treated with different therapy approaches. Introducing planned screening of BK virus reactivation in newly transplanted patients allows timely therapeutic intervention.
Keywords
BK virus
BK-virusom uzrokovana nefropatija
imunosupresivna terapija
Keywords (english)
BK virus
BK virus-associated nephropathy
immunosupresive therapy
Language croatian URN:NBN urn:nbn:hr:105:883663 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2018-12-19 09:10:02
