Management of BK nephropathy in a patient with renal transplantation: a balance of immunosuppression and rejection

• Published in: Hong Kong journal of nephrology Vol. 5; no. 1; pp. 29 - 33
• Main Authors: CHEUK, Au, WONG, Sze-Ho, CHU, Kwok-Hong, LEE, William, TANG, Hon-Lok, TSANG, Wai-Kay, FUNG, Samuel Ka-Shun, MAK, Yuen-Fun, CHAN, Hilda Wai-Han, TONG, Matthew Kwok-Lung
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 2003
• Subjects: BK nephropathy; Graft dysfunction; Polyomavirus; BK nephropathy; Graft dysfunction; Polyomavirus
• ISSN: 1561-5413; 1876-4371
• DOI: 10.1016/S1561-5413(09)60100-9

Polyomavirus type BK was first recognized in 1971 from the urine of a renal transplant recipient with unilateral ureteral stenosis. BK virus-related nephropathy was rarely reported before 1995. However, this virus has recently been reported as a cause of interstitial nephritis up to 5% of renal transplant recipients. Persistent polyomavirus replication in renal allograft recipients was identified as an important cause of progressive graft dysfunction and graft loss, especially among those treated with strong immunosuppressive regimens. We report on a case of type BK virus nephropathy in our centre. The definitive diagnosis is based on renal biopsy findings. The presence of abundant decoy cells in urine is a valuable adjuvant diagnostic parameter. The detection of BK virus DNA in the plasma by polymerase-chain-reaction assay is a promising screening tool. Cautious use of immunosuppressive therapy to balance the risk between graft rejection and viral replication is the mainstay treatment at present for BK virus nephropathy in renal transplant recipients. Future development of antiviral therapy and improvement in diagnostic tools are needed.