The Korean Journal of Medicine

  • 제81권4호
  • /
  • Pages.512-516
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

면역글로불린과 Leflunomide로 치료한 BK 바이러스 신병증 1예

A Case of Combining Intravenous Immunoglobulin and Leflunomide for BK Nephropathy

  • 조선영 (중앙대학교 의과대학 내과학교실) ;
  • 배정모 (서울대학교 의과대학 병리학교실) ;
  • 남우진 (중앙대학교 의과대학 내과학교실) ;
  • 김진건 (중앙대학교 의과대학 내과학교실) ;
  • 김수현 (중앙대학교 의과대학 내과학교실) ;
  • 오동진 (중앙대학교 의과대학 내과학교실) ;
  • 유석희 (중앙대학교 의과대학 내과학교실)
  • Cho, Sun-Young (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Bae, Jeong-Mo (Department of Pathology, Seoul National University College of Medicine) ;
  • Nam, Woo-Jin (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Jin-Gun (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Su-Hyun (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Oh, Dong-Jin (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Yu, Suk-Hee (Department of Internal Medicine, Chung-Ang University College of Medicine)
  • 발행 : 2011.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

저자들은 면역억제제의 감량과 항바이러스제치료에도 진행하는 BK 바이러스 신병증을 면역글로불린으로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

BK virus nephropathy has emerged as an important cause of renal allograft dysfunction. It affects 1-10% of renal transplant patients and results in significant graft dysfunction in more than 50% of cases. A reduction in the amount of immunosuppressants is not an appropriate treatment option for advanced stage BK nephropathy; therefore, other treatment strategies need to be considered such as cidofovir, leflunomide, and intravenous immunoglobulin (IVIG) in combination with reduced immunosuppression. The use of IVIG may be a valuable treatment option in patients with BK virus nephropathy. We report our experience with IVIG rescue therapy in a patient and the progression of BK nephropathy despite leflunomide therapy.

키워드

참고문헌

  1. Son YK, Oh JS, Oh HJ, Shin YH, Kim JK, Jeong HJ. Leflunomide treatment in BK virus associated nephropathy after renal transplantation. Korean J Nephrol 2009;28:211-218.
  2. Brennan DC, Agha I, Bohl DL, et al. Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction. Am J Transplant 2005;5:582-594. https://doi.org/10.1111/j.1600-6143.2005.00742.x
  3. Randhawa P, Brennan DC. BK virus infection in transplant recipients: an overview and update. Am J Transplant 2006;6:2000-2005. https://doi.org/10.1111/j.1600-6143.2006.01403.x
  4. Binet I, Nickeleit V, Hirsch HH, et al. Polyomavirus disease under new immunosuppressive drugs: a cause of renal graft dysfunction and graft loss. Transplantation 1999;67:918-922. https://doi.org/10.1097/00007890-199903270-00022
  5. Hirsch HH, Brennan DC, Drachenberg CB, et al. Polyomavirusassociated nephropathy in renal transplantation: interdisciplinary analyses and recommendations. Transplantation 2005;79:1277-1286. https://doi.org/10.1097/01.TP.0000156165.83160.09
  6. Howell DN, Smith SR, Butterly DW, et al. Diagnosis and management of BK polyomavirus interstitial nephritis in renal transplant recipients. Transplantation 1999;68:1279-1288. https://doi.org/10.1097/00007890-199911150-00011
  7. Waldman WJ, Knight DA, Blinder L, et al. Inhibition of cytomegalovirus in vitro and in vivo by the experimental immunosuppressive agent leflunomide. Intervirology 1999;42:412-418. https://doi.org/10.1159/000053979
  8. Williams JW, Javaid B, Kadambi PV, et al. Leflunomide for polyomavirus type BK nephropathy. N Engl J Med 2005;352:1157-1158. https://doi.org/10.1056/NEJM200503173521125
  9. Faguer S, Hirsch HH, Kamar N, et al. Leflunomide treatment for polyomavirus BK-associated nephropathy after kidney transplantation. Transpl Int 2007;20:962-969. https://doi.org/10.1111/j.1432-2277.2007.00523.x
  10. Josephson MA, Gillen D, Javaid B, et al. Treatment of renal allograft polyoma BK virus infection with leflunomide. Transplantation 2006;81:704-710. https://doi.org/10.1097/01.tp.0000181149.76113.50
  11. Leca N, Muczynski KA, Jefferson JA, et al. Higher levels of leflunomide are associated with hemolysis and are not superior to lower levels for BK virus clearance in renal transplant patients. Clin J Am Soc Nephrol 2008;3:829-835. https://doi.org/10.2215/CJN.03930907
  12. Lee JS, Jeon JS, Han DC, Song D, Moon C. Effect of high dose intravenous immunoglobulins on the treatment of antibody mediated humoral rejection and BK virus infection in renal transplant recipients. J Korean Soc Transplant 2007;21:140-142.
  13. Sener A, House AA, Jevnikar AM, et al. Intravenous immunoglobulin as a treatment for BK virus associated nephropathy: one-year follow-up of renal allograft recipients. Transplantation 2006;81:117-120. https://doi.org/10.1097/01.tp.0000181096.14257.c2