The Urinary Polyomavirus-Haufen Test: A Highly Predictive Non-Invasive Biomarker to Distinguish "Presumptive" from "Definitive" Polyomavirus Nephropathy: How to Use It-When to Use It-How Does It Compare to PCR Based Assays?

被引:8
作者
Nickeleit, Volker [1 ]
Davis, Vicki G. [1 ]
Thompson, Bawana [1 ]
Singh, Harsharan K. [1 ]
机构
[1] UNC Sch Med, Div Nephropathol, Brinkhous Bullitt Bldg,Room 409,Campus Box 7525, Chapel Hill, NC 27599 USA
来源
VIRUSES-BASEL | 2021年 / 13卷 / 01期
基金
美国国家卫生研究院;
关键词
biomarker; biopsy; BK-virus; diagnosis; electron microscopy; histology; kidney transplantation; disease classes; urine; viral load; RENAL-TRANSPLANT RECIPIENTS; BK-VIRUS NEPHROPATHY; WORKING CLASSIFICATION; ALLOGRAFT RECIPIENTS; ACCURATELY PREDICTS; REPLICATION; INFECTION; IMMUNOSUPPRESSION; DISEASE; KIDNEY;
D O I
10.3390/v13010135
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
"Definitive" biopsy proven polyomavirus nephropathy (PyVN), usually caused by BK polyomavirus (BKPyV), remains a significant infection of kidney transplants. Diagnosis depends upon an allograft biopsy and outcome depends upon early intervention. Here, we report data on a non-invasive biomarker for PyVN, the urinary PyV-Haufen test. Test results were compared to those of conventional laboratory assays targeting PyV replication, i.e., BKPy-viremia, -viruria and urinary decoy cell shedding. Of 809 kidney transplant recipients, 228 (28%) showed PyV replication with decoy cell shedding and/or BKPy-viremia by quantitative PCR; only a subset of 81/228 (36%) showed "definitive" PyVN. Sensitivity and specificity for identifying patients with PyVN was: 100% and 98%, respectively, urinary PyV-Haufen test; 50% and 54%, respectively, urinary decoy cell shedding; 97% and 32%, respectively, BKPy-viremia with cut-off of >= 250 viral copies/mL; 66% and 80%, respectively, for BKPy-viremia >= 10(4) viral copies/mL. The PyV-Haufen test showed a very strong correlation with the severity of PyVN (Spearman's rho = 0.84) and the Banff PyVN disease classes (p < 0.001). In comparison, BKPy-viremia and -viruria levels by PCR displayed modest correlations with PyVN severity (Spearman's rho = 0.35 and 0.36, respectively) and were not significantly associated with disease classes. No association was found between decoy cell shedding and PyVN severity or disease classes. Pilot data demonstrated that PyVN resolution with decreasing Banff pvl-scores was reflected by a gradual decrease in PyV-Haufen shedding; such a tight association was not noted for BKPy-viremia. In conclusion, urinary PyV-Haufen testing is a highly specific, non-invasive method to accurately diagnose patients with "definitive" PyVN and to optimize patient management. Assay specifics are discussed.
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页数:19
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