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The BK virus in renal transplant recipients—review of pathogenesis, diagnosis, and treatment

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Abstract

The BK virus, a DNA virus from the Polyomavirus group, represents an opportunistic infection of immunosuppressed transplant recipients. Though the virus was discovered approximately 40 years ago, the emergence of BK virus nephropathy since 1995 onwards, with associated high graft loss rates, has revolutionized renal transplantation medicine. Kidney transplant professionals realized that the consequences of over-immunosuppression were as severe as the consequences of under-immunosuppression and we entered the era of immunosuppressive minimization. Despite this recognition, the optimal testing type for BK virus infections and frequency of testing are hotly debated. Similarly, optimal treatment strategies remain sources of intense controversy. The authors review the current strategies of screening, diagnosis, and possible treatment, and also review the amount and quality of evidence in favor or against. Similarities and differences between cytomegalovirus, Epstein-Barr virus, and BV virus, the three major viral infections in kidney transplantation, are highlighted.

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Abbreviations

BKV:

BK virus

CMV:

Cytomegalovirus

EBV:

Epstein–Barr virus

BKVN:

BK virus nephropathy

UNOS/OPTN:

United Network of Organ Sharing/Organ Procurement and Transplant Network

KDIGO:

Kidney Disease Improving Global Outcomes

AST:

American Society of Transplantation

PPV:

Positive predictive value

NPV:

Negative predictive value

References

  1. Stewart SE, Eddy BE, Borgese N (1958) Neoplasms in mice inoculated with a tumor agent carried in tissue culture. J Natl Cancer Inst 20:1223–1243

    CAS  PubMed  Google Scholar 

  2. Gardner SD, Field AM, Coleman DV, Hulme B (1971) New human papovavirus (B.K.) isolated from urine after renal transplantation. Lancet 1:1253–1257

    CAS  PubMed  Google Scholar 

  3. Rosen S, Harmon W, Krensky AM, Edelson PJ, Padgett BL, Grinnell BW, Rubino MJ, Walker DL (1983) Tubulo-interstitial nephritis associated with polyomavirus (BK type) infection. N Engl J Med 308:1192–1196

    CAS  PubMed  Google Scholar 

  4. Purighalla R, Shapiro R, McCauley J, Randhawa P (1995) BK virus infection in a kidney allograft diagnosed by needle biopsy. Am J Kidney Dis 26:671–673

    CAS  PubMed  Google Scholar 

  5. Ramos E, Drachenberg CB, Papadimitriou JC, Hamze O, Fink JC, Klassen DK, Drachenberg RC, Wiland A, Wali R, Cangro CB, Schweitzer E, Bartlett ST, Weir MR (2002) Clinical course of polyoma virus nephropathy in 67 renal transplant patients. J Am Soc Nephrol 13:2145–2151

    PubMed  Google Scholar 

  6. Pappo O, Demetris AJ, Raikow RB, Randhawa PS (1996) Human polyoma virus infection of renal allografts: histopathologic diagnosis, clinical significance, and literature review. Mod Pathol 9:105–109

    CAS  PubMed  Google Scholar 

  7. Acott PD, Hirsch HH (2007) BK virus infection, replication, and diseases in pediatric kidney transplantation. Pediatr Nephrol 22:1243–1250

    PubMed  PubMed Central  Google Scholar 

  8. Pahari A, Rees L (2003) BK virus-associated renal problems–clinical implications. Pediatr Nephrol 18:743–748

    PubMed  Google Scholar 

  9. Humar A, Michaels M (2006) American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation. Am J Transplant 6:262–274

    CAS  PubMed  Google Scholar 

  10. Dharnidharka VR, Cherikh WS, Abbott KC (2009) An OPTN analysis of national registry data on treatment of BK virus allograft nephropathy in the United States. Transplantation 87:1019–1026

    PubMed  Google Scholar 

  11. Ginevri F, De Santis R, Comoli P, Pastorino N, Rossi C, Botti G, Fontana I, Nocera A, Cardillo M, Ciardi MR, Locatelli F, Maccario R, Perfumo F, Azzi A (2003) Polyomavirus BK infection in pediatric kidney-allograft recipients: a single-center analysis of incidence, risk factors, and novel therapeutic approaches. Transplantation 75:1266–1270

    CAS  PubMed  Google Scholar 

  12. Haysom L, Rosenberg AR, Kainer G, Waliuzzaman ZM, Roberts J, Rawlinson WD, Mackie FE (2004) BK viral infection in an Australian pediatric renal transplant population. Pediatr Transplant 8:480–484

    CAS  PubMed  Google Scholar 

  13. Hymes LC, Warshaw BL (2006) Polyomavirus (BK) in pediatric renal transplants: evaluation of viremic patients with and without BK associated nephritis. Pediatr Transplant 10:920–922

    PubMed  Google Scholar 

  14. Fogeda M, Munoz P, Luque A, Morales MD, Bouza E (2007) Cross-sectional study of BK virus infection in pediatric kidney transplant recipients. Pediatr Transplant 11:394–401

    CAS  PubMed  Google Scholar 

  15. Herman J, Van Ranst M, Snoeck R, Beuselinck K, Lerut E, Van Damme-Lombaerts R (2004) Polyomavirus infection in pediatric renal transplant recipients: evaluation using a quantitative real-time PCR technique. Pediatr Transplant 8:485–492

    PubMed  Google Scholar 

  16. Alexander RT, Langlois V, Tellier R, Robinson L, Hebert D (2006) The prevalence of BK viremia and urinary viral shedding in a pediatric renal transplant population: a single-center retrospective analysis. Pediatr Transplant 10:586–592

    PubMed  Google Scholar 

  17. Smith JM, Dharnidharka VR, Talley L, Martz K, McDonald RA (2007) BK virus nephropathy in pediatric renal transplant recipients: an analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry. Clin J Am Soc Nephrol 2:1037–1042

    PubMed  Google Scholar 

  18. Muller A, Beck B, Theilemann K, Stapenhorst L, Licht C, Michalk D, Franzen C, Hoppe B (2005) Detection of polyomavirus BK and JC in children with kidney diseases and renal transplant recipients. Pediatr Infect Dis J 24:778–781

    PubMed  Google Scholar 

  19. Hirsch HH, Knowles W, Dickenmann M, Passweg J, Klimkait T, Mihatsch MJ, Steiger J (2002) Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. N Engl J Med 347:488–496

    PubMed  Google Scholar 

  20. Bressollette-Bodin C, Coste-Burel M, Hourmant M, Sebille V, Andre-Garnier E, Imbert-Marcille BM (2005) A prospective longitudinal study of BK virus infection in 104 renal transplant recipients. Am J Transplant 5:1926–1933

    CAS  PubMed  Google Scholar 

  21. Goraya N, Narayanan M, Jaffers G (2009) Biopsy proven BK polyoma nephropathy in the presence of viruria and lack of viremia. Am J Transplant 9:426A

    Google Scholar 

  22. Hirsch HH, Steiger J (2003) Polyomavirus BK. Lancet Infect Dis 3:611–623

    PubMed  Google Scholar 

  23. Low JA, Magnuson B, Tsai B, Imperiale MJ (2006) Identification of gangliosides GD1b and GT1b as receptors for BK virus. J Virol 80:1361–1366

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Eash S, Querbes W, Atwood WJ (2004) Infection of vero cells by BK virus is dependent on caveolae. J Virol 78:11583–11590

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Egli A, Infanti L, Dumoulin A, Buser A, Samaridis J, Stebler C, Gosert R, Hirsch HH (2009) Prevalence of polyomavirus BK and JC infection and replication in 400 healthy blood donors. J Infect Dis 199:837–846

    CAS  PubMed  Google Scholar 

  26. Stolt A, Sasnauskas K, Koskela P, Lehtinen M, Dillner J (2003) Seroepidemiology of the human polyomaviruses. J Gen Virol 84:1499–1504

    CAS  PubMed  Google Scholar 

  27. Coleman DV, Gardner SD, Field AM (1973) Human polyomavirus infection in renal allograft recipients. Br Med J 3:371–375

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Flaegstad T, Ronne K, Filipe AR, Traavik T (1989) Prevalence of anti BK virus antibody in Portugal and Norway. Scand J Infect Dis 21:145–147

    CAS  PubMed  Google Scholar 

  29. Hirsch HH, Randhawa P (2009) BK virus in solid organ transplant recipients. Am J Transplant 9(Suppl 4):S136–S146

    PubMed  Google Scholar 

  30. Bijol V, Cimic A, Viscidi RP, Hymes LC (2010) Pretransplant IgG antibodies to polyoma BK virus in pediatric renal transplants. Pediatr Transplant 14:224–227

    CAS  PubMed  Google Scholar 

  31. Smith JM, McDonald RA, Finn LS, Healey PJ, Davis CL, Limaye AP (2004) Polyomavirus nephropathy in pediatric kidney transplant recipients. Am J Transplant 4:2109–2117

    PubMed  Google Scholar 

  32. Bohl DL, Storch GA, Ryschkewitsch C, Gaudreault-Keener M, Schnitzler MA, Major EO, Brennan DC (2005) Donor origin of BK virus in renal transplantation and role of HLA C7 in susceptibility to sustained BK viremia. Am J Transplant 5:2213–2221

    CAS  PubMed  Google Scholar 

  33. Womer KL, Huang Y, Herren H, Dibadj K, Peng R, Murawski M, Shraybman R, Patton P, Clare-Salzler MJ, Kaplan B (2010) Dendritic cell deficiency associated with development of BK viremia and nephropathy in renal transplant recipients. Transplantation 89:115–123

    PubMed  Google Scholar 

  34. Comoli P, Azzi A, Maccario R, Basso S, Botti G, Basile G, Fontana I, Labirio M, Cometa A, Poli F, Perfumo F, Locatelli F, Ginevri F (2004) Polyomavirus BK-specific immunity after kidney transplantation. Transplantation 78:1229–1232

    PubMed  Google Scholar 

  35. Binggeli S, Egli A, Schaub S, Binet I, Mayr M, Steiger J, Hirsch HH (2007) Polyomavirus BK-specific cellular immune response to VP1 and large T-antigen in kidney transplant recipients. Am J Transplant 7:1131–1139

    CAS  PubMed  Google Scholar 

  36. Dharnidharka VR, Tejani AH, Ho PL, Harmon WE (2002) Post-transplant lymphoproliferative disorder in the United States: young Caucasian males are at highest risk. Am J Transplant 2:993–998

    PubMed  Google Scholar 

  37. Gosert R, Rinaldo CH, Funk GA, Egli A, Ramos E, Drachenberg CB, Hirsch HH (2008) Polyomavirus BK with rearranged noncoding control region emerge in vivo in renal transplant patients and increase viral replication and cytopathology. J Exp Med 205:841–852

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Randhawa P, Zygmunt D, Shapiro R, Vats A, Weck K, Swalsky P, Finkelstein S (2003) Viral regulatory region sequence variations in kidney tissue obtained from patients with BK virus nephropathy. Kidney Int 64:743–747

    CAS  PubMed  Google Scholar 

  39. Weiss AS, Gralla J, Chan L, Klem P, Wiseman AC (2008) Aggressive immunosuppression minimization reduces graft loss following diagnosis of BK virus-associated nephropathy: a comparison of two reduction strategies. Clin J Am Soc Nephrol 3:1812–1819

    PubMed  PubMed Central  Google Scholar 

  40. Hymes LC, Greenbaum L, Amaral SG, Warshaw BL (2007) Surveillance renal transplant biopsies and subclinical rejection at three months post-transplant in pediatric recipients. Pediatr Transplant 11:536–539

    PubMed  Google Scholar 

  41. Manitpisitkul W, Drachenberg C, Ramos E, Munivenkatappa R, Philosophe B, Klassen D, Haririan A (2009) Maintenance immunosuppressive agents as risk factors for BK virus nephropathy: a case-control study. Transplantation 88:83–88

    PubMed  Google Scholar 

  42. Egli A, Kohli S, Dickenmann M, Hirsch HH (2009) Inhibition of polyomavirus BK-specific T-Cell responses by immunosuppressive drugs. Transplantation 88:1161–1168

    CAS  PubMed  Google Scholar 

  43. Vasudev B, Hariharan S, Hussain SA, Zhu YR, Bresnahan BA, Cohen EP (2005) BK virus nephritis: risk factors, timing, and outcome in renal transplant recipients. Kidney Int 68:1834–1839

    PubMed  Google Scholar 

  44. Thomas A, Dropulic LK, Rahman MH, Geetha D (2007) Ureteral stents: a novel risk factor for polyomavirus nephropathy. Transplantation 84:433–436

    PubMed  Google Scholar 

  45. Brennan DC, Agha I, Bohl DL, Schnitzler MA, Hardinger KL, Lockwood M, Torrence S, Schuessler R, Roby T, Gaudreault-Keener M, Storch GA (2005) Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction. Am J Transplant 5:582–594

    CAS  PubMed  Google Scholar 

  46. Dharnidharka VR, Araya CE, Wadsworth CS, McKinney MC, Howard RJ (2008) Assessing the value of ureteral stent placement in pediatric kidney transplant recipients. Transplantation 85:986–991

    PubMed  Google Scholar 

  47. Funk GA, Gosert R, Comoli P, Ginevri F, Hirsch HH (2008) Polyomavirus BK replication dynamics in vivo and in silico to predict cytopathology and viral clearance in kidney transplants. Am J Transplant 8:2368–2377

    CAS  PubMed  Google Scholar 

  48. Awadalla Y, Randhawa P, Ruppert K, Zeevi A, Duquesnoy RJ (2004) HLA mismatching increases the risk of BK virus nephropathy in renal transplant recipients. Am J Transplant 4:1691–1696

    CAS  PubMed  Google Scholar 

  49. Singh HK, Andreoni KA, Madden V, True K, Detwiler R, Weck K, Nickeleit V (2009) Presence of urinary Haufen accurately predicts polyomavirus nephropathy. J Am Soc Nephrol 20:416–427

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Singh HK, Donna Thompson B, Nickeleit V (2009) Viral Haufen are urinary biomarkers of polyomavirus nephropathy: New diagnostic strategies utilizing negative staining electron microscopy. Ultrastruct Pathol 33:222–235

    PubMed  Google Scholar 

  51. Preiksaitis JK, Pang XL, Fox JD, Fenton JM, Caliendo AM, Miller GG (2009) Interlaboratory comparison of Epstein-Barr virus viral load assays. Am J Transplant 9:269–279

    CAS  PubMed  Google Scholar 

  52. Pang XL, Fox JD, Fenton JM, Miller GG, Caliendo AM, Preiksaitis JK (2009) Interlaboratory comparison of cytomegalovirus viral load assays. Am J Transplant 9:258–268

    CAS  PubMed  Google Scholar 

  53. Bechert CJ, Schnadig VJ, Payne DA, Dong J (2010) Monitoring of BK viral load in renal allograft recipients by real-time PCR assays. Am J Clin Pathol 133:242–250

    CAS  PubMed  Google Scholar 

  54. Hirsch HH, Drachenberg CB, Steiger J, Ramos E (2006) Polyomavirus-associated nephropathy in renal transplantation: critical issues of screening and management. Adv Exp Med Biol 577:160–173

    CAS  PubMed  Google Scholar 

  55. Kidney Disease Improving Global Outcomes (KDIGO) Transplant Work Group (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9(Suppl 3):S1–S155

    Google Scholar 

  56. Liptak P, Kemeny E, Ivanyi B (2006) Primer: histopathology of polyomavirus-associated nephropathy in renal allografts. Nat Clin Pract Nephrol 2:631–636

    PubMed  Google Scholar 

  57. Drachenberg CB, Papadimitriou JC, Hirsch HH, Wali R, Crowder C, Nogueira J, Cangro CB, Mendley S, Mian A, Ramos E (2004) Histological patterns of polyomavirus nephropathy: correlation with graft outcome and viral load. Am J Transplant 4:2082–2092

    PubMed  Google Scholar 

  58. Hirsch HH, Brennan DC, Drachenberg CB, Ginevri F, Gordon J, Limaye AP, Mihatsch MJ, Nickeleit V, Ramos E, Randhawa P, Shapiro R, Steiger J, Suthanthiran M, Trofe J (2005) Polyomavirus-associated nephropathy in renal transplantation: interdisciplinary analyses and recommendations. Transplantation 79:1277–1286

    PubMed  Google Scholar 

  59. Bohl DL, Brennan DC (2007) BK virus nephropathy and kidney transplantation. Clin J Am Soc Nephrol 2(Suppl 1):S36–S46

    CAS  PubMed  Google Scholar 

  60. Randhawa PS, Schonder K, Shapiro R, Farasati N, Huang Y (2010) Polyomavirus BK neutralizing activity in human immunoglobulin preparations. Transplantation 89:1462–1465

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Gabardi S, Waikar SS, Martin S, Roberts K, Chen J, Borgi L, Sheashaa H, Dyer C, Malek SK, Tullius SG, Vadivel N, Grafals M, Abdi R, Najafian N, Milford E, Chandraker A (2010) Evaluation of fluoroquinolones for the prevention of BK viremia after renal transplantation. Clin J Am Soc Nephrol 5:1298–1304

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Boothpur R, Brennan DC (2010) Human polyoma viruses and disease with emphasis on clinical BK and JC. J Clin Virol 47:306–312

    PubMed  PubMed Central  Google Scholar 

  63. Laskin BL, Goebel J (2010) Cost-efficient screening for BK virus in pediatric kidney transplantation: A single-center experience and review of the literature. Pediatr Transplant. doi:https://doi.org/10.1111/j.1399-3046.2010.01408.x

    PubMed  Google Scholar 

  64. Kiberd BA (2005) Screening to prevent polyoma virus nephropathy: a medical decision analysis. Am J Transplant 5:2410–2416

    PubMed  Google Scholar 

  65. Nolte FS (2006) Case studies in cost effectiveness of molecular diagnostics for infectious diseases: pulmonary tuberculosis, enteroviral meningitis, and BK virus nephropathy. Clin Infect Dis 43:1463–1467

    PubMed  Google Scholar 

  66. Smith F, Panek R, Kiberd BA (2009) Screening to prevent polyoma virus nephropathy in kidney transplantation: a cost analysis. Am J Transplant 9:2177–2179

    CAS  PubMed  Google Scholar 

  67. Hardinger KL, Koch MJ, Bohl DJ, Storch GA, Brennan DC (2010) BK-virus and the impact of pre-emptive immunosuppression reduction: 5-year results. Am J Transplant 10:407–415

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Johnston O, Jaswal D, Gill JS, Doucette S, Fergusson DA, Knoll GA (2010) Treatment of polyomavirus infection in kidney transplant recipients: a systematic review. Transplantation 89:1057–1070

    PubMed  Google Scholar 

  69. Cheeseman SH, Black PH, Rubin RH, Cantell K, Hirsch MS (1980) Interferon and BK Papovavirus–clinical and laboratory studies. J Infect Dis 141:157–161

    CAS  PubMed  Google Scholar 

  70. Puliyanda DP, Toyoda M, Traum AZ, Flores FX, Jordan S, Moudgil A, Somers MJ (2008) Outcome of management strategies for BK virus replication in pediatric renal transplant recipients. Pediatr Transplant 12:180–186

    PubMed  Google Scholar 

  71. Araya CE, Lew JF, Fennell RS, Neiberger RE, Dharnidharka VR (2006) Intermediate-dose cidofovir without probenecid in the treatment of BK virus allograft nephropathy. Pediatr Transplant 10:32–37

    CAS  PubMed  Google Scholar 

  72. Araya CE, Lew JF, Fennell RS, Neiberger RE, Dharnidharka VR (2008) Intermediate dose cidofovir does not cause additive nephrotoxicity in BK virus allograft nephropathy. Pediatr Transplant 12:790–795

    CAS  PubMed  Google Scholar 

  73. Vats A, Shapiro R, Singh Randhawa P, Scantlebury V, Tuzuner A, Saxena M, Moritz ML, Beattie TJ, Gonwa T, Green MD, Ellis D (2003) Quantitative viral load monitoring and cidofovir therapy for the management of BK virus-associated nephropathy in children and adults. Transplantation 75:105–112

    CAS  PubMed  Google Scholar 

  74. Zavos G, Gazouli M, Psimenou E, Papaconstantinou I, Bokos J, Boletis J, Zografidis A, Kostakis A (2004) Polyomavirus BK infection in Greek renal transplant recipients. Transplant Proc 36:1413–1414

    CAS  PubMed  Google Scholar 

  75. Wu JK, Harris MT (2008) Use of leflunomide in the treatment of polyomavirus BK-associated nephropathy. Ann Pharmacother 42:1679–1685

    CAS  PubMed  Google Scholar 

  76. Araya CE, Garin EH, Neiberger RE, Dharnidharka VR (2009) Leflunomide therapy for BK virus allograft nephropathy in pediatric and young adult kidney transplant recipients. Pediatr Transplant 14:145–150

    PubMed  Google Scholar 

  77. Hilton R, Tong CY (2008) Antiviral therapy for polyomavirus-associated nephropathy after renal transplantation. J Antimicrob Chemother 62:855–859

    CAS  PubMed  Google Scholar 

  78. Hymes L (2010) BK virus nephropathy: a pediatric nephrologist's perspective. Transplant Rev (Orlando) 24:28–31

    Google Scholar 

  79. Sener A, House AA, Jevnikar AM, Boudville N, McAlister VC, Muirhead N, Rehman F, Luke PP (2006) Intravenous immunoglobulin as a treatment for BK virus associated nephropathy: one-year follow-up of renal allograft recipients. Transplantation 81:117–120

    CAS  PubMed  Google Scholar 

  80. Sharma AP, Moussa M, Casier S, Rehman F, Filler G, Grimmer J (2009) Intravenous immunoglobulin as rescue therapy for BK virus nephropathy. Pediatr Transplant 13:123–129

    CAS  PubMed  Google Scholar 

  81. Randhawa PS (2005) Anti-BK virus activity of ciprofloxacin and related antibiotics. Clin Infect Dis 41:1366–1367, author reply 1367

    PubMed  Google Scholar 

  82. Dropulic LK, Jones RJ (2008) Polyomavirus BK infection in blood and marrow transplant recipients. Bone Marrow Transplant 41:11–18

    CAS  PubMed  Google Scholar 

  83. Josephson MA, Williams JW, Chandraker A, Randhawa PS (2006) Polyomavirus-associated nephropathy: update on antiviral strategies. Transpl Infect Dis 8:95–101

    CAS  PubMed  Google Scholar 

  84. Dharnidharka VR, Cherikh WS, Neff R, Cheng Y, Abbott KC (2010) Retransplantation after BK virus nephropathy in prior kidney transplant: an OPTN database analysis. Am J Transplant 10:1312–1315

    CAS  PubMed  Google Scholar 

  85. Almeras C, Foulongne V, Garrigue V, Szwarc I, Vetromile F, Segondy M, Mourad G (2008) Does reduction in immunosuppression in viremic patients prevent BK virus nephropathy in de novo renal transplant recipients? A prospective study. Transplantation 85:1099–1104

    CAS  PubMed  Google Scholar 

  86. Bennett WM, Meyer L, Ridenour J, Batiuk TD (2010) Surveillance and Modification of Immunosuppression Minimizes BK Virus Nephropathy. Am J Nephrol 32:10–12

    PubMed  Google Scholar 

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Acknowledgements/Disclosures

Dr. Dharnidharka is the recipient of honoraria from Genzyme and is a consultant for Bristol-Myers-Squibb.

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  1. Division of Pediatric Nephrology, University of Florida College of Medicine & Shands Children’s Hospital, 1600 SW Archer Road, PO Box 100296/HD 214, Gainesville, FL, 32610-0296, USA

    Vikas R. Dharnidharka, Husam A. Abdulnour & Carlos E. Araya

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  1. Vikas R. Dharnidharka
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Correspondence to Vikas R. Dharnidharka.

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Dharnidharka, V.R., Abdulnour, H.A. & Araya, C.E. The BK virus in renal transplant recipients—review of pathogenesis, diagnosis, and treatment. Pediatr Nephrol 26, 1763–1774 (2011). https://doi.org/10.1007/s00467-010-1716-6

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