Noninvasive prognostication of polyomavirus BK virus-associated nephropathy.
Noninvasive prognostication of polyomavirus BK virus-associated nephropathy.
复制标题
DOI：
10.1097/tp.0b013e31829acb38
复制
发表时间：
2013-07-27
期刊：
影响因子：
6.2
通讯作者：
Suthanthiran M
中科院分区：
文献类型：
--
作者：
Dadhania D;Snopkowski C;Muthukumar T;Lee J;Ding R;Sharma VK;Christos P;Bang H;Kapur S;Seshan SV;Suthanthiran M
BK virus associated nephropathy (BKVN) is associated with an increased risk of graft failure. Levels of mRNAs encoding proteins implicated in inflammation and fibrosis were measured in urine collected at the time of biopsy diagnosis of BKVN in 29 kidney graft recipients, and analyzed for prognosticating graft failure using logistic regression. Ten of 29 BKVN patients had graft failure within 36 months of BKVN diagnosis and the remaining 19 patients did not. Serum creatinine level, BKVN biopsy stage and urinary cell levels of mRNA for PAI-1, vimentin, TIMP-1, fibronectin, granzyme B or perforin were associated with graft failure. A combination of PAI-1 mRNA level, BKVN biopsy stage and creatinine level (P=0.0015, by logistic regression) and a combination of PAI-1 mRNA level and creatinine level (P=0.001) were the best fitting models for prognosticating graft failure, and PAI-1 mRNA level was the only independent predictor (OR=2.8; 95% CI: 1.1 to 6.8, P=0.03) by multivariable analysis. The AUC for the combination of PAI-1 mRNA, biopsy and creatinine was 0.92 (95% CI: 0.80 to 1.0, P<0.001) by ROC curve analysis, and the AUC was 0.92 (95% CI: 0.80 to 1.0, P<0.001) for the combination of PAI-mRNA and creatinine. Graft outcome was correctly predicted in 27 of 29 BKVN patients by either model. Urinary cell level of PAI-1 mRNA, measured at the time of BKVN diagnosis, is an independent prognosticator of graft failure and a prediction model of serum creatinine and PAI mRNA is as accurate as the model that includes the biopsy result.
