Polyomavirus-associated nephropathy (PVAN) is common in kidney transplant patients, but infrequent following hematopoietic stem cell transplantation (HSCT). Aside from reduction of immunosuppression, few therapeutic options exist for treatment of PVAN. In the May issue of AJKD, Papanicolaou et al report a case of PVAN in a severely immunocompromised allogeneic HSCT recipient treated with brincidofovir without reduction of immunosuppression. Brincidofovir is an orally bioavailable lipid acyclic nucleoside phosphonate that undergoes intracellular conversion to cidofovir-diphosphate. The following questions based on the article will test your knowledge on on PVAN.
1. Numerous factors can reduce glomerular filtration rate following HSCT. Which of the following is least likely?
A. Radiation therapy
B. Calcineurin inhibitors (CNIs)
C. Bacterial infections
2. The SUPPRESS trial is an ongoing trial to demonstrate efficacy and safety of brincidofovir against which of the following viruses?
A. Prevention of cytomegalovirus (CMV)
B. Prevention of PVAN
C. Prevention of adenovirus
D. Prevention of herpes simplex virus
3. Which of the following biopsy features are seen in BK virus nephropathy? (select all that apply)
A. Interstitial fibrosis and tubular atrophy
B. Arterial intimal thickening and hyaline arteriosclerosis
C. Tubular inflammation with marked neutrophilic infiltrate
D. Intranuclear inclusion bodies which stain positive for large T antigen
4. Which of the following agents has been disproven to prevent PVAN in kidney transplant recipients?
A. High dose cidofovir
Post prepared by Dr. Jyotsana Thakkar, Nephrology Fellow, Hofstra NSLIJ School of Medicine, and Dr. Kenar D. Jhaveri, AJKD Blog Editor.
To see the answers, please click here.