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Blood, and not urine, BK viral load predicts renal outcome in children with hemorrhagic cystitis following hematopoietic stem cell transplantation.

Abstract
BK virus is a significant cause of hemorrhagic cystitis after hematopoietic stem cell transplantation (HSCT). However, its role in nephropathy post-HSCT is less studied. We retrospectively evaluated clinical outcomes in pediatric HSCT patients with hemorrhagic cystitis. Although most of these patients had very high urine BK viral loads (viruria), patients with higher BK plasma loads (viremia) had significant renal dysfunction, a worse clinical course, and decreased survival. Patients with a peak plasma BK viral load of >10,000 copies/mL (high viremia) were more likely to need dialysis and aggressive treatment for hemorrhagic cystitis compared to patients with ≤ 10,000 copies/mL (low viremia). Conversely, most patients with low viremia had only transient elevations in creatinine, and less severe hemorrhagic cystitis that resolved with supportive therapy. Overall survival (OS) at 1 year post-HSCT was 89% in the low viremia group and 48% in the high viremia group. We conclude that the degree of BK viremia, and not viruria, may predict renal, urologic, and overall outcome in the post-HSCT population.
AuthorsHilary L Haines, Benjamin L Laskin, Jens Goebel, Stella M Davies, Hong J Yin, Julia Lawrence, Parinda A Mehta, Jack J Bleesing, Alexandra H Filipovich, Rebecca A Marsh, Sonata Jodele
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 17 Issue 10 Pg. 1512-9 (Oct 2011) ISSN: 1523-6536 [Electronic] United States
PMID21385622 (Publication Type: Clinical Trial, Journal Article)
CopyrightCopyright © 2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Creatinine
Topics
  • BK Virus
  • Child
  • Creatinine (blood, urine)
  • Cystitis (blood, etiology, mortality, urine, virology)
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Hemorrhage (blood, etiology, mortality, urine, virology)
  • Humans
  • Male
  • Polyomavirus Infections (blood, etiology, mortality, urine)
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Transplantation, Homologous
  • Viral Load
  • Viremia

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