Objective:To summarize the incidence, treatment and prognosis of BK virus (BKV) infection in renal transplant recipients.Methods:The clinical data of recipients who underwent renal transplantation in the First Hospital of Jilin University from December 2015 to December 2018 and were regularly followed up and monitored for BKV infection were retrospectively analyzed to observe the incidence of each stage of BKV infection and the therapeutic effect and outcome.Results:As of June 2019, the median follow-up time of 629 renal transplant recipients was 16 months. The incidence of BK viruria was 24.5% (154/629), and the detection time was (5.3±5.0) months after surgery; the incidence of BK viremia was 7.5% (47/629), and the detection time was (8.2±7.4) months after surgery; the incidence of BK virus nephropathy (BKVN) was 4.3% (27/629), the detection time was (14.5±8.4) months after surgery, and the incidence of renal allograft failure was 1.9% (12/629). The incidence of BKV infection is high within 12 months after renal transplantation. Among the 154 recipients with BK viruria after renal transplantation, 30 recipients with low-level BK viruria were treated with a close follow-up monitoring regimen, and 124 recipients with high-level BKV urination were treated with a rapid dose reduction regimen of immunosuppressive agents; 35.7% (55/154) had a decrease in urine BKV DNA load to a low level, 23.4% (36/154) had a negative urine BKV, 24.7% (38/154) had a persistently high urine BKV DNA load, 8.4% (13/154) progressed to BK viremia, 7.8% (12/154) progressed to BKVN, and no renal allograft failure occurred. Among the 47 recipients with BK viremia after renal transplantation, 44 were treated with immunosuppressant conversion regimen and 3 with immunosuppressant rapid dose reduction regimen; 55.3% (26/47) had negative serum BKV, 31.9% (15/47) progressed to BKVN, and 12.8% (6/47) had persistently positive serum BKV. All 27 BKVN recipients after renal transplantation were treated with immunosuppressant conversion+ antiviral treatment therapy; 63.0% (17/27) had negative serum BKV, 22.2% (6/27) had persistently positive serum BKV, all had abnormal renal allograft function, and 14.8% (4/27) had renal allograft failure.Conclusions:The incidence of BKV infection is high at 1-year after renal transplantation. Regular screening of BKV during this period is of great significance for early detection of infection and preemptive treatment.

Objective:To investigate the clinical significance of regular monitoring of BK virus (BKV) infection on the prognosis of BK virus nephropathy (BKVN) after renal transplantation.Methods:Thirty-six renal transplant recipients with pathologically confirmed BKVN from 2015 to 2018 in our center were selected as the research objects. According to their BKV monitoring, the recipients were divided into active monitoring group (15 cases) and passive discovery group (21 cases). The detection time of BKV urination and blood, BKVDNA load, time to diagnosis of BKVN, serum and urine BKV conversion after treatment and renal allograft function were observed in the two groups.Results:The detection time of BKV, BKV and BKVN was (5.3±3.4) months, (7.8±3.8) months and (10.3±7.4) months, respectively. There were significant differences in the proportion of recipients with serum BKV conversion (14/15 and 11/21) and urine BKV conversion (12/15 and 10/21) in the passive monitoring group after treatment (χ2=0.029 and 0.012, P<0.05). The time of urine BKV conversion in the subjective monitoring group was (3.3±3.2) months after treatment, and the time of serum BKV conversion was (0.8±0.7) months after treatment, which were earlier than those in the passive discovery group [(5.6±2.1) months and (3.6±2.1) months], and the differences were statistically significant (t=0.041 and 0.027, all P<0.05). The proportion of recipients who developed renal allograft failure/insufficiency was lower in the active monitoring group (4/15) than in the passive discovery group (13/21), and the difference was statistically significant (χ2=0.015, P<0.05).Conclusions:Active and regular monitoring of BKV after renal transplantation is helpful for early diagnosis of BKVN, increasing the proportion of BKV conversion, shortening the time of BKV conversion and reducing the occurence of renal allograft failure.

目的 探讨学习肾窦区囊肿的诊断、鉴别诊断及治疗方法 .方法 回顾性分析吉林大学第一医院泌尿外二科于2018年10月收治的1例肾窦内肾盂旁囊肿伴出血患者的临床资料案例,总结并讨论学习肾窦区囊肿的临床表现特点、诊断及鉴别诊断方法以及治疗方式选择.结果 根据患者临床表现、检验及相关影像学检查术前诊断为肾盂癌,治疗方案为:行后腹腔镜下左肾根治性切除术,开放左侧下段输尿管及部分膀胱切除术;术后严密随访复查.患者手术过程顺利,病理为肾窦内肾盂旁囊肿伴陈旧性出血,血肿形成.患者术后未出现相关术后并发症,术后第4天顺利出院,术后3个月复查无远期并发症出现.结论 肾窦区囊肿是一种特殊类型肾脏囊性疾病,诊断与鉴别诊断主要依靠影像学检查,临床诊断难度大,需与肾积水及肾窦区肿瘤相鉴别以明确诊断,对治疗方案选择和家庭社会影响具有重要的临床意义.