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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Screening tests for BK polyomavirus-associated nephropathy (BKPyVAN)[1-4]

Screening tests for BK polyomavirus-associated nephropathy (BKPyVAN)[1-4]
Method Sensitivity* (%) Specificity* (%) PPV* NPV* Advantage Disadvantage
Plasma quantitative PCR (preferred) 100 88Δ Moderate High
  • High PPV for BKPyVAN if VL ≥10,000/mL plasma
  • Ability to monitor response to therapy (ie, reduction in immunosuppression)
  • Relatively expensive
  • Nonstandardized significant variability among assays
  • Rare reports of biopsy-confirmed BKPyVAN without concomitant viremia/DNAemia
Urine quantitative PCR 100 78 Moderate High
  • Precedes BKPyV viremia by 6 to 12 weeks
  • Earlier identification of patients at risk for subsequent BKPyVAN
  • Limited utility for monitoring response to therapy (ie, immunosuppression reduction)
  • May remain persistently positive
Urine decoy cells 100 71 Low High
  • Lower cost
  • Decoy cells identification needs experience
  • Does not distinguish among polyomaviruses (ie, JCPyV versus BKPyV)
Urine Haufen 100 99 High High
  • High PPV
  • Might be useful in settings where allograft biopsy is not feasible
  • Requires electron microscopy
  • Not widely available
PPV: positive predictive value; NPV: negative predictive value; PCR: polymerase chain reaction; VL: viral load; BKPyV: BK polyomavirus; JCPyV: JC polyomavirus.
* For detecting histologically confirmed BKPyVAN.
¶ Plasma qualitative PCR is also available but has limited clinical value and should generally not be used.
Δ Specificity increases to 90% if viral load is greater than 10,000 copies/mL of blood.
References:
  1. Hirsch HH, Knowles W, Dickenmann M, et al. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. N Engl J Med 2002; 347:488.
  2. Singh HK, Andreoni KA, Madden V, et al. Presence of urinary Haufen accurately predicts polyomavirus nephropathy. J Am Soc Nephrol 2009; 20:416.
  3. Nickeleit V, Klimkait T, Binet IF, et al. Testing for polyomavirus type BK DNA in plasma to identify renal-allograft recipients with viral nephropathy. N Engl J Med 2000; 342:1309.
  4. Bechert CJ, Schnadig VJ, Payne DA, Dong J. Monitoring of BK viral load in renal allograft recipients by real-time PCR assays. Am J Clin Pathol 2010; 133:242.
Adapted from: Elfadawy N, Yamada M, Sarabu N. Management of BK polyomavirus infection in kidney and kidney-pancreas transplant recipients: A review article. Infect Dis Clin North Am 2018; 32:599.
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