Abstract:
:BK virus nephropathy and cellular rejection are common causes of allograft dysfunction in renal transplant recipients. The two can be difficult to distinguish on allograft biopsy and can be present simultaneously. Management of the patient with coexistent BK infection and rejection is complicated by the conflicting ideals of decreasing immunosuppression to treat the former and increasing immunosuppression to treat the latter. The authors present the case of a 57-year-old renal transplant recipient who underwent allograft biopsy 8 weeks post-transplant for evaluation of increased serum creatinine in the setting of BK viremia (BKV). Biopsy revealed Banff classification 1b acute cellular rejection, with insufficient evidence to diagnose BK virus-associated nephropathy. The patient was administered intravenous immune globulin (IVIG), with no other changes in immunosuppressive therapy. Plasma and urine BK increased exponentially following IVIG administration, and allograft function further deteriorated. Repeat biopsy showed overt BK viral nephropathy, and BKV and creatinine decreased only after reduction in immunosuppression and initiation of leflunomide. Although case series have suggested a potential role for IVIG in the setting of BK infection, further study is needed to define the safety and efficacy of this approach.
journal_name
Mil Medjournal_title
Military medicineauthors
Boonyapredee M,Knight K,Little Ddoi
10.7205/MILMED-D-13-00489subject
Has Abstractpub_date
2014-06-01 00:00:00pages
e699-702issue
6eissn
0026-4075issn
1930-613Xjournal_volume
179pub_type
杂志文章abstract::This quality improvement project implemented and evaluated an evidence-based practice (EBP) program at two Army outpatient health care facilities. The EBP program consisted of five implementation strategies that aimed to inculcate EBP into organizational culture as well as nursing practice and culture. A conceptual mo...
journal_title:Military medicine
pub_type: 临床试验,杂志文章
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journal_title:Military medicine
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doi:10.7205/milmed-d-10-00219
更新日期:2011-03-01 00:00:00
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更新日期:2017-03-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章,多中心研究
doi:
更新日期:2002-02-01 00:00:00
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journal_title:Military medicine
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更新日期:2007-12-01 00:00:00
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doi:
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更新日期:2010-10-01 00:00:00
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doi:10.7205/MILMED-D-13-00186
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journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1993-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2008-04-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1999-11-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:
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journal_title:Military medicine
pub_type: 杂志文章
doi:
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更新日期:2011-07-01 00:00:00
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doi:
更新日期:2003-07-01 00:00:00
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更新日期:2005-05-01 00:00:00
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更新日期:2017-03-01 00:00:00
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pub_type: 历史文章,杂志文章
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更新日期:2011-06-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1994-03-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1991-05-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:
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