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BK Nephropathy Banff PVN Classification — ESENeph MCQ

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HardTransplantationBK Nephropathy Banff PVN ClassificationESENeph

A kidney transplant recipient 6 months post-transplant develops progressive renal dysfunction. Biopsy shows polyomavirus cytopathic changes (ground-glass nuclear inclusions) confirmed by SV40 immunohistochemistry. BK viral load is 120000 copies/mL. What histological grading system classifies BK nephropathy severity?

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Correct answer: B — The Banff working group PVN (polyomavirus nephropathy) classification: pvl (viral cytopathic changes) grades 1-3 and ci (interstitial fibrosis) scores determine severity and prognosis

The Banff working group established a specific classification for polyomavirus nephropathy (PVN) in kidney transplants. It grades pvl (polyomavirus load in the tissue: pvl1 = <25% of biopsy cores; pvl2 = 25-50%; pvl3 = >50%) and integrates ci (chronic interstitial fibrosis) scores to determine prognosis. Higher pvl and ci scores predict worse graft outcomes. SV40 immunohistochemistry is more sensitive than routine histology for detecting viral cytopathic changes. This classification helps guide the aggressiveness of immunosuppression reduction.

Reference: Nickeleit et al 2018 – Banff Working Group PVN; KDIGO 2009 – Transplant