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Kidney disorders associated with human polyomavirus in renal transplant patients: 2 case reports Two girls aged 12 and 14 years (patients 1 and 2, respectively) developed kidney disorders associated with human polyomavirus (BK virus), while receiving ciclosporin, mycophenolate mofetil and prednisolone for immunosuppression. The girls underwent kidney transplantation and received ciclosporin, mycophenolate mofetil and prednisolone [dosages not stated]. Six to 9 months after transplantation, both girls presented with acute allograft dysfunction (serum creatinine levels 4.4 mg/dL and 4.1 mg/dL, respectively). Rejection was apparent from renal ultrasonography and radionuclide renal scans. Ciclosporin was reduced in both patients. Rejection was then confirmed on renal biopsies, which also showed evidence of human polyomavirus. PCR analysis revealed human polyomavirus DNA in the girls’ serum and urine. In both girls the prednisolone doses were reduced, mycophenolate mofetil and ciclosporin were discontinued, and sirolimus and leflunamide were initiated. They also received immunoglobulin. There had been no improvement in renal function after 13 weeks (in patient 1) and 6 weeks (in patient 2), and cidofovir was then prescribed for 20 weeks. After 12 weeks of therapy, patient 1 developed dyspnoea and fever, and was diagnosed with pericardial effusion. PCA analysis of the pericardial fluid was positive for human polyomavirus DNA. The viral load in both the urine and plasma decreased at weeks 18 (patient 1) and 15 (patient 2), but despite an eventual negative viral load, the function of the allografts progressively worsened. The grafts failed at 12 to 16 months after transplantation. Patient 1 underwent retransplantation 9 months after the detection of human polyomavirus. At last follow-up, patient 2 had a stable creatinine level, and she was receiving renal replacement therapy. Fidan K, et al. BK virus-associated nephropathy in two pediatric kidney recipients. Transplantation Proceedings 40: 310-312, No. 1, Jan-Feb 2008 801100795 Turkey

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Reactions 23 Feb 2008 No. 1190