Kidney Week

Abstract: SA-PO116

Urinary Cell BKV-VP1 mRNA Levels in Early Symptomatic Hemorrhagic Cystitis and Kidney Injury in Hematopoietic Stem Cell Transplant Recipients

Session Information

• Onconephrology: Clinical and Research Advances - II
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States

Victoria Gutgarts,

• Snopkowski, Catherine, Weill Cornell Medicine, New York, New York, United States

Catherine Snopkowski,

• Lee, Yeon Joo, Memorial Sloan Kettering Cancer Center, New York, New York, United States

Yeon Joo Lee,

• Jakubowski, Ann A., Memorial Sloan Kettering Cancer Center, New York, New York, United States

Ann A. Jakubowski,

• Papanicolaou, Genovefa A., Memorial Sloan Kettering Cancer Center, New York, New York, United States

Genovefa A. Papanicolaou,

• Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States

Ilya Glezerman,

• Suthanthiran, Manikkam, Weill Cornell Medicine, New York, New York, United States

Manikkam Suthanthiran,

• Dadhania, Darshana M., Weill Cornell Medicine, New York, New York, United States

Darshana M. Dadhania,

Background

Asymptomatic BK virus (BKV) viruria is frequent (up to 60%) peri hematopoietic stem cell transplantation (HCT), however a minority develop BKV hemorrhagic cystitis (HC). We aimed to determine if BKV-VP1 mRNA levels, previously validated urinary biomarker of BKV nephropathy (Dadhania et al, Transplantation 2010) can predict HC and acute kidney injury (AKI) within 3 months of HCT.

Methods

Urine samples were collected prospectively from adults undergoing first allogeneic HCT at MSKCC. 4 samples (median) per patient were collected within 3 months of HCT. Urine cell pellets were prepared, total RNA isolated and reverse transcribed to cDNA. Real-time quantitative PCR was used to measure BKV-VPI mRNA copy number/ug of total RNA. HC was defined as grades 1 to 4; microscopic to macroscopic hematuria with clots, respectively. AKI was defined as Cr > 1.5x baseline at 3 months of HCT.

Results

19 HCT recipients (median age 45, range 24-73, 53% acute leukemia) were profiled and 5 (26%) developed symptomatic HC (4 graded as 1, 1 graded as 3) within 3 months. Eight patients developed AKI at 3 months, majority grade 1. The Figure below shows the average number of BKV VP1 copies per patient. Although the median number of copies were not significantly different between those who developed symptomatic HC and not and those who developed AKI and not in the first three months of HCT, levels in 4 patients exceeded BKV nephropathy (BKVN) diagnostic threshold (>6.5×10⁸ BKV VP1 mRNA /microgram RNA).

Conclusion

Our novel finding that the BKV VP1 mRNA level exceeded BKVN diagnostic threshold in 21% cases raise the hypothesis that BKVN may be an underappreciated entity in HCT recipients.