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El Nov 20, 2003 12:38 pm, Text-Conference November 19 dijo:
[22:56] (Speaker> POLYOMAVIRUS INFECTIONS OF RENAL ALLOGRAFTS
[22:56] (Speaker> Volker Nickeleit 1 and M.J. Mihatsch2
[22:57] (Speaker> Introduction:
[23:00] (Speaker> ________ introduction is over_______
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[23:00] (MJesus> thanks!!
[23:01] (MJesus> please, question and commentary....
[23:02] (volker> What is the prevalence of BKN in your centers?
[23:03] (MJesus> In renal allograph ?
[23:03] (volker> yes
[23:03] (gtorres> the infection by polyomavirus is similar to a chronic rejection?
[23:03] (MJesus> still don't have renal trasplantation in our Hospital
[23:04] (volker> No it is not. BKN affects tubular epithelial cells and causes tubular atrophy. Chronic rejection is characterized by sclerosis of renal arteries and remodeling of glomeruli.
[23:06] (MJesus> how long do you consider may be the screening period for BKN in trasplantation ?
[23:06] (gtorres> but in the clinica as it is demonstrated?
[23:08] (gtorres> it is an alteration of alloinjerto
[23:08] (Hellden> Do you know what have caused the change in prevalence?
[23:09] (volker> Screening should be done in stable patients for weeks. If decoy cells and plasma PCR give positive results, a stable graft recipient should be biopsied to establish a diagnosis of BKN.
[23:10] (volker> The high prevalence of BKN is at least in part caused by administration of new highly potent immunosuppressive drugs, in particular high dose tacrolimus and MMF.
[23:11] (DrMusso> Which are the therapeutical options against this virus?
[23:11] (Hellden> Which also have increased the incidence of CMV infections?
[23:12] (volker> Urine cytology and decoy cells only serve as an adjunct diagnostic tool to identify patients at risk for BKN. A diagnosis of BKN has to be established in a graft biopsy showing typical inclusion bodies.
[23:13] (gtorres> this is exact
[23:14] (volker> BKN is most commonly "treated" by lowering immunosuppression, often switching patients from tacrolimus and MMF to CyA and AZA. Benefical effects have also been reported with the nephrotoxic drug Cidofovir and most recently with Leflunomide.
[23:14] (volker> However, treatment strategies are poorly defined.
[23:15] (volker> CMV infections with manifest changes in the allograft have not increased in recent years.
[23:17] (MJesus> what the index of diagnose of BKN, by the urine cytology preparations ?
[23:18] (volker> Please specify
[23:18] (DrMusso> CMV has been related with atherosclerosis process, Is there any similar evidence regarding BKN?
[23:19] (Hellden> I have a feeling that CMV has increased. We analyse an increasing number of concentrations of ganciclovir against CMV.
[23:20] (volker> I do not believe that there is a direct positive link between arteriosclerosis and CMV infections but that question is open for further debates. Since BK virus, practically always affects epithelial cells and not endothelial cells, I do not see a role for BK virus in the pathogenesis of arteriosclerosis.
[23:21] (volker> I am looking at renal allografts through the microscope. From this angle, manifest CMV infections have not increased.
[23:21] (MJesus> how many cases of BKN are discover by urinary citology? 100 %... 20% ?
[23:22] (volker> As I said, urine cytology and decoy cells are adjunct tools. You can only establish the diagnosis of BKN in urine cytology specimens if you detect decoy cell casts indicating their intraparenchymal renal origin.
[23:23] (volker> The positive predictive value of decoy cells for BKN is around 30%.
[23:23] (MJesus> thanks...
[23:24] (volker> you're welcome
[23:24] (MJesus> really there is not too frequent to find this cells in unine
[23:26] (volker> Decoy cells can be seen sometimes in low numbers in approximately 25% of all renal allograft recipients at sometime post-transplantation, most commonly in the first two years. High numbers of decoy cells are seen in 5-7% of patients.
[23:27] (MJesus> indeed the diagnosis includin necesarely the bioopsy ?
[23:27] (MJesus> biopsy ?
[23:29] (MJesus> indeed... the diagnosis always includes the biopsy?
[23:29] (volker> Yes, BKN has to be diagnosed histologically in a renal allograft biopsy showing typical intranuclear viral inclusions in epithelial cells. Ultimate goal is to diagnose BKN at an early stage when tubulointerstitial damage is limited and potentially fully reversible.
[23:31] (MJesus> thanks !
[23:34] (gtorres> but poliomavirus is more frequent in the transplants of heart
and lung. he is this correct one?
[23:35] (volker> No! BK Virus nephropathy is practically exclusively seen in renal allografts. There is only one case reporting BKN in a native kidney following pancreas transplantation. BKN has not been reported after heart or lung transplantation.
[23:36] (gtorres> thanks
[23:37] (Hellden> The new kind of immunosuppressiv drugs may cause new kind of infections, right?
[23:37] (Hellden> Not cause, find!
[23:38] (volker> Right. I fear that we may see more cases of adenovirus infections for the same reasons in the future.
[23:38] (DrMusso> The BK mechanism of damage acts attracting the immunological system against tubular cells?, since it attacks the virus but as a consequence it attacks the cell that contains this virus??
[23:39] (volker> Often suprisingly limited cellular reactions towards BK virus replication in tubular cells are noted. The virus seems in part controlled by antibodies.
[23:40] (DrMusso> So the damage is directly done by the virus itself.
[23:41] (Hellden> I also say good night to Europe and Good Morning to America. See you all and thanks again for chat:))
[23:41] (volker> Yes. BKN is characterized by virally induced tubular epithelial cell necrosis secondary to cell lysis following intracellular viral replication.
[23:43] (DrMusso> So we could say that in the moderm transplantology field we have trhee variable to consider: rejection, toxicity and virus infection.
[23:43] (volker> That is a fair statement.
[23:43] (DrMusso> Thanks
[23:44] (MJesus> thanks !!!
[23:44] (volker> In addition, of course, other injuries such as recurrent glomerulonephritis or hypertension can injure the graft.
[23:46] (gtorres> Dr volker and dr. Musso thanks for its collaboration
[23:46] (MJesus> indeed.... is you have not more questions or commentary now... we could to end here. We have loggin this discussion and will be placed in the discussion boar tomorrow, where it could continue (the discussion).
Tomorrow, there are more conferences. Thanks you very much !
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[23:46] (DrMusso> Thanks to you and to Dr Volker
[23:46] (volker> I enjoyed very much discussing viral infections with you!!
[23:48] (volker> See you all soon! Good night!
[23:48] (DrMusso> Good night and see you tomorrow!
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