Renal transplantation and JC & BK polyoma virus induced nephropathy
How effective are these therapies?
First you have to make sure you reduced the immunosupression most as far as possible and Cidofovir or lefkunomide might be used . Cifoovir has to be adjusted to GFR and if GFR is lower than a certain level can't use this drug
There is no definite treatment for polyomavirus associated nephropathy (PVAN). Reduced immunosuppression is the most effective treatment so far. Target blood levels are recommended to be reduced 30-50% from the baseline. Leflunomide (LF) and Cidofovir have been used but their efficacy was not confirmed, specially they both have serious side effects. Our recent data showed that low BK viral load at the onset of diagnosis (< 10,000c /mL), female recipients, late onset BK viremia (> 6 months) are all favorable prognostic factors. When LF is used, it should be used as a second line after failure of reduced immunosuppression. Leflunomide – when used, should be initiated at 100 mg/day for 5 days followed by a maintenance daily dose of 40 mg/day targeting teriflunomide levels at 60 000 ng/ml. Blood. Levels should be monitored frequently to avoid toxicity. Cipro can be added 250–500 mg bid. Watch tendonitis! Good luck :-)
After confirming the diagnosis, the only therapeutic intervention that has acceptable results is reducing the immunosuppressive treatment. Non of the mentioned medications has a proven efficacy.
I concur with the suggestions of my colleague fro Tel Aviv who recommended reducing immunosuppression and trying Cidofovir. In cases where there is concurrent ACMR, some experts recommend treating the ACMR and then quickly reducing the immunosuppression regimen.
Reduced immunosuppression is the most effective treatment .Cidofovir or lefkunomide might be used but their efficacy was not confirmed
No antiviral is really effective "in vivo"...the only treatment is reducing immunosuppression until T-cell immunoreactivity against BKV (monitored by means of Elispot or a similar assay) develops.
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