[BK virus nephropathy in a kidney transplant recipient: a case report and literature review].
BK virus nephropathy (BKVN) has emerged as an important cause of allograft dysfunction and loss in kidney transplant recipients. We present a case in a 30-year-old female who underwent ABO-compatible living kidney transplant from her mother and was maintained with tacrolimus, mycophenolate mofetil and prednisolone. The serum creatinine level was stabilized about 0.9 mg/dl on postoperative day (POD) 35. On POD258, the serum creatinine increased to 1.8 mg/dl and the patient received methylpredonisolone pulse therapy under the diagnosis of acute rejection, which resulted in further increase in creatinine level from 1.8 to 2.6 mg/dl. Urine cytology showed decoy cells, but renal biopsy specimen showed no evidence of viral infection. Despite histopathological findings, positive urine and serum BKV-DNA suggested that allograft dysfunction was caused by BKVN. Therefore, the immunosuppession was reduced and gamma-globuline was given for 2 weeks. After the treatment, urine cytology became negative for decoy cells and serum creatinine level recovered to 2.0 mg/dl. On POD456, serum creatinine level was stabilized about 1.8 mg/dl and decoy cells remained negative.
The Department of Urology, Graduate school of medicine, Kyoto University.
Akio
A
Hoshi
Takehiko
T
Segawa
Takeshi
T
Takahashi
Eijiro
E
Nakamura
Shin
S
Higashi
Noriyuki
N
Ito
Shingo
S
Yamamoto
Toshiyuki
T
Kamoto
Osamu
O
Ogawa
D000328:Adult; D001739:BK Virus; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D027601:Polyomavirus Infections / Q000209:etiology*; D011183:Postoperative Complications; D014412:Tumor Virus Infections / Q000209:etiology*
D004279:DNA, Viral