Noninvasive prognostication of polyomavirus BK virus-associated nephropathy.

Abstract:

BACKGROUND:BK virus-associated nephropathy (BKVN) is associated with an increased risk of graft failure. METHODS:Levels of mRNAs encoding proteins implicated in inflammation and fibrosis were measured in urine collected at the time of biopsy diagnosis of BKVN in 29 kidney graft recipients and analyzed for prognosticating graft failure using logistic regression. RESULTS:Ten of 29 BKVN patients had graft failure within 36 months of BKVN diagnosis and the remaining 19 patients did not. Serum creatinine level, BKVN biopsy stage, and urinary cell levels of mRNA for plasminogen activator inhibitor (PAI)-1, vimentin, tissue inhibitor of metalloproteinase-1, fibronectin, granzyme B, or perforin were associated with graft failure. A combination of PAI-1 mRNA level, BKVN biopsy stage, and creatinine level (P = 0.0015, by logistic regression) and a combination of PAI-1 mRNA and creatinine levels (P = 0.001) were the best-fitting models for prognosticating graft failure, and PAI-1 mRNA level was the only independent predictor (odds ratio, 2.8; 95% confidence interval [CI], 1.1-6.8; P = 0.03) by multivariable analysis. The area under the curve for the combination of PAI-1 mRNA, biopsy, and creatinine was 0.92 (95% CI, 0.80-1.0; P < 0.001) by receiver operating characteristic curve analysis, and the area under the curve was 0.92 (95% CI, 0.80-1.0; P < 0.001) for the combination of PAI-1 mRNA and creatinine. Graft outcome was correctly predicted in 27 of 29 BKVN patients by either model. CONCLUSION:Urinary cell level of PAI-1 mRNA, measured at the time of BKVN diagnosis, is an independent prognosticator of graft failure and a prediction model of serum creatinine and PAI-1 mRNA is as accurate as the model that includes the biopsy result.

journal_name

Transplantation

journal_title

Transplantation

authors

Dadhania D,Snopkowski C,Muthukumar T,Lee J,Ding R,Sharma VK,Christos P,Bang H,Kapur S,Seshan SV,Suthanthiran M

doi

10.1097/TP.0b013e31829acb38

subject

Has Abstract

pub_date

2013-07-27 00:00:00

pages

131-8

issue

2

eissn

0041-1337

issn

1534-6080

journal_volume

96

pub_type

杂志文章
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    pub_type: 杂志文章

    doi:

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    doi:

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    pub_type: 杂志文章

    doi:10.1097/01.TP.0000047030.38665.0D

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