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Blood, and Not Urine, BK Viral Load Predicts Renal Outcome in Children with Hemorrhagic Cystitis following Hematopoietic Stem Cell Transplantation Hilary L. Haines, Benjamin L. Laskin, Jens Goebel, Stella M. Davies, Hong J. Yin, Julia Lawrence, Parinda A. Mehta, Jack J. Bleesing, Alexandra H. Filipovich, Rebecca A. Marsh, Sonata Jodele Biology of Blood and Marrow Transplantation Volume 17, Issue 10, Pages (October 2011) DOI: /j.bbmt Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions
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Figure 1 Renal biopsy in patient with BK infection and TA-TMA: renal biopsy showed mild inflammatory infiltrate in the interstitium, mild interstitial fibrosis, and tubular atrophy. Most of the capillaries were patent, but with focal segmental mild thickening of glomerular capillary walls with a double contour appearance (A, trichrome stain, 60×), consistent with expansion of the subendothelial zone. Electron microscopy showed irregular electron-lucent expansion of the subendothelial zone (double arrows) because of acute endothelial cell damage with neo-membrane formation. The capillary lumen was occluded by thrombi (B). With no immunoglobulin deposition, these changes are diagnostic for thrombotic microangiopathy. Many tubular epithelial cells had large, homogenous, intranuclear inclusions (arrows) with a ground-glass appearance (C, H&E, 40×), representing aggregations of viral particles in the nucleus. BK virus in situ hybridization demonstrated positive staining in the nucleus (D, 40×). Electron microscopic study also revealed 40- to 45-nm electron-dense virions in the nucleus (not shown). Biology of Blood and Marrow Transplantation , DOI: ( /j.bbmt ) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions
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Figure 2 Overall survival (OS) after HSCT according to BK viremia level. Kaplan-Meier estimated OS was calculated starting from HSCT date (day 0, or stem cell infusion date) till the last date of contact or death for patients with low BK viremia (≤10,000 copies/mL) and patients with high BK viremia (>10,000 copies/mL). Vertical hatched lines represent day +100 and day +365 following HSCT. Biology of Blood and Marrow Transplantation , DOI: ( /j.bbmt ) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions
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