Renal Function Impairment in Kidney Transplantation: Importance of Early BK Virus Detection.

BACKGROUND: BK virus allograft nephropathy is a major complication of kidney transplantation that markedly reduces graft survival (50% graft failure 24 months after being diagnosed). BK virus replication can occur at any time posttransplantation. Viruria detection is a signal of virus reactivation and precedes viremia. Only viremia has been related to BK nephropathy. Early detection appears to be important in the prevention of BK nephropathy. METHODS: Using serial follow-up of BK infection, we sought to determine the association of BK virus infection with kidney function impairment. We included all solitary kidney recipients transplanted between February 1, 2010 and December 31, 2014 and followed for at least 1 year. Viruria at >107 copies/mL, viremia at >104 copies/mL, or biopsy-proven BK nephropathy were indicative of positivity. Various recipient, donor, and transplant characteristics were registered. Creatinine level was measured at 3, 6, 9, and 12 months and while virus replication was detected. P < .05 was considered statistically significant. RESULTS: Two hundred fifty-four kidney recipients were included. Viruria was detected in 73 of them (28.74%), of whom 32 (12.6%) also had viremia. Of the 32 recipients with viremia, 7 had biopsy-proven nephropathy. Only viremia positivity had a negative effect on kidney function (P < .01). One of 32 viremia-positive recipients had graft loss (3.1%). CONCLUSION: Serial monitoring for BK virus replication is important for detection of BK infection. Early BK detection appears crucial to prevent impairment of kidney function and subsequent graft loss.

[Plasmapheresis: its use in multiple sclerosis and other demyelinating processes of the central nervous system. An observation study]. / Plasmaféresis: su utilidad en esclerosis múltiple y otros procesos desmielinizantes del sistema nervioso central. Estudio observacional.

INTRODUCTION: We present a retrospective observation study aimed at analyzing the value of plasmapheresis in the management of patients with multiple sclerosis (MS) and other acute demyelinating processes affecting the central nervous system (CNS) who show severe exacerbations that do not respond well to conventional therapy with corticoids. PATIENTS AND METHODS: A total of 11 patients were included in the study: nine with MS, one disseminated acute encephalomyelitis and one case of transverse myelitis. All of them presented an acute or subacute neurological deficit, which prevented them from carrying out their day to day activities, with or without repercussions on the EDSS, and with the risk of suffering a severe residual disability after not responding to intravenous methylprednisolone pulses. Each patient was submitted to three exchanges per week, for 2 weeks, with association of orally administered prednisone and they were then evaluated after the last session and at one, six and twelve months. RESULTS: Following plasmapheresis all the patients experienced a significant drop in disability and seven of them (77.7% of the total number with MS) even improved during the first month with respect to their basal situation ( an extension of the Lazarus effect ). After a year s follow up, 100% of the patients still maintained the basal situation that was recovered from before exacerbation, and only two relapses were recorded. The patients with MS presented a transient exacerbation after the second exchange. New therapy with immunosuppressants, immunomodulators or both was associated in eight cases. CONCLUSIONS: We consider plasmapheresis to be a safe, effective therapeutic procedure in the management of patients with MS and other demyelinating processes affecting the CNS. Its use should be considered as first choice in severe relapses and in swiftly progressing forms that do not respond to intravenous methylprednisolone.

Plasmaféresis: su utilidad en la esclerosis múltiple y otros procesos desmielinizantes del sistema nervioso central. Estudio observacional / Plasmaféresis: su utilidad en la esclerosis múltiple y otros procesos desmielinizantes del sistema nervioso central. Estudio observacional

Introducción. Presentamos un estudio observacional, retrospectivo, cuyo objetivo es analizar la utilidad de la plasmaféresis en el manejo de pacientes con esclerosis múltiple (EM) y otros procesos desmielinizantes agudos del sistema nervioso central (SNC) que presentan exacerbaciones graves rebeldes a la terapia convencional con corticoides. Pacientes y métodos. Incluimos 11 pacientes: nueve con EM, uno con encefalomielitis aguda diseminada y uno con mielitis transversa. Todos presentaban un déficit neurológico agudo o subagudo que les impedía la realización de sus actividades habituales, con o sin repercusión sobre la EDSS (escala ampliada del grado de discapacidad de Kurtzke), y con riesgo de sufrir discapacidad residual grave tras no responder a pulsos de metilprednisolona intravenosa. Cada paciente se sometió a tres recambios por semana, durante 2 semanas, con asociación de prednisona oral, y se evaluó tras la última sesión, al mes, a los seis y a los 12 meses. Resultados. Tras la plasmaféresis, todos experimentaron una reducción de la discapacidad significativa, y siete de ellos (77,7 por ciento del total con EM) incluso mejoraron respecto a su situación basal durante el primer mes (`ampliación del efecto Lázaro'). Tras un año de seguimiento, el 100 por ciento de los pacientes mantenía su recuperada situación basal anterior al empeoramiento, y se registraron únicamente dos brotes. Los pacientes con EM presentaron un `empeoramiento transitorio' tras el segundo recambio. Se asoció un nuevo tratamiento inmunosupresor, inmunomodulador, o ambos, en ocho casos. Conclusiones. Consideramos que la plasmaféresis es un procedimiento terapéutico eficaz y seguro en el manejo del paciente con EM y otros procesos desmielinizantes del SNC. Su utilización se debería considerar como de elección en los brotes graves y en formas con rápida progresión que no responden a la metilprednisolona intravenosa (AU)

Introduction. We present a retrospective observation study aimed at analyzing the value of plasmapheresis in the management of patients with multiple sclerosis (MS) and other acute demyelinating processes affecting the central nervous system (CNS) who show severe exacerbations that do not respond well to conventional therapy with corticoids. Patients and methods. A total of 11 patients were included in the study: nine with MS, one disseminated acute encephalomyelitis and one case of transverse myelitis. All of them presented an acute or subacute neurological deficit, which prevented them from carrying out their day-to-day activities, with or without repercussions on the EDSS, and with the risk of suffering a severe residual disability after not responding to intravenous methylprednisolone pulses. Each patient was submitted to three exchanges per week, for 2 weeks, with association of orally-administered prednisone and they were then evaluated after the last session and at one, six and twelve months. Results. Following plasmapheresis all the patients experienced a significant drop in disability and seven of them (77.7% of the total number with MS) even improved during the first month with respect to their basal situation (‘an extension of the Lazarus effect’). After a year’s follow-up, 100% of the patients still maintained the basal situation that was recovered from before exacerbation, and only two relapses were recorded. The patients with MS presented a ‘transient exacerbation’ after the second exchange. New therapy with immunosuppressants, immunomodulators or both was associated in eight cases. Conclusions. We consider plasmapheresis to be a safe, effective therapeutic procedure in the management of patients with MS and other demyelinating processes affecting the CNS. Its use should be considered as first choice in severe relapses and in swiftly progressing forms that do not respond to intravenous methylprednisolone (AU)