RESEARCH ARTICLE


Intravenous Immunoglobulin in BK Virus Nephropathy



I. Anyaegbu Elizabeth 1, *, P. Hmiel Stanley 2
1 Driscoll Children’s Hospital, Kidney Center, Corpus Christi, Texas, USA
2 Washington University School of Medicine, Division of Pediatric Nephrology, St Louis, Missouri, USA


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Creative Commons License
©Anyaegbu and Hmiel.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the University of Texas Medical Branch, Pediatric Nephrology, Driscoll Children’s Hospital Kidney Center, 3533 South Alameda Street, Corpus Christi, Texas, USA; Tel: (361) 694-6732; Fax: (361) 694-6859; E-mail: Elizabeth.Anyaegbu@dchstx.org


Abstract

The incidence of post transplant viral infections has increased with the use of more potent immunosuppressive regimens. Consequently, BK virus nephropathy (BKVN) has arisen as a significant cause of graft dysfunction and loss. Reduction of immunosuppression is the first line management of post-transplant viral infections. Other therapies such as intravenous immunoglobulin (IVIg), cidofovir, leflunomide and fluoroquinolones have been tried with varying degrees of success.

We report our experience with IVIg in three pediatric renal transplant recipients who presented with allograft dysfunction. First, we describe two cases of biopsy proven BKVN, one diagnosed with undetectable viral titers in plasma, demonstrating that BKVN can occur even at low viral loads. We also present a pediatric renal transplant recipient with persistent BK viremia and allograft dysfunction who responded to therapy with recovery of renal function and clearance of viremia. Therefore we conclude that IVIg is efficacious in the treatment of persistent BK viremia and BKVN. The appropriate dose, frequency and duration of therapy require further study.

Keywords: Allograft dysfunction, BK viremia, BK virus nephropathy (BKVN), immunosuppression reduction, intravenous immunoglobulin (IVIg), pediatric transplantation..