title: BK virus nephropathy is not always alone.
abstract: BACKGROUND
  BK virus associated allograft nephropathy (BKVAN) is an important cause of allograft lost that often occurs in the first year of transplantation. The state of over immunosuppression also predispose these patients to various opportunistic viral infection Objectives: This research aimed to study the renal transplanted patients for BK viremia and BKVAN.
  
  
  METHODS
  This observational study was conducted between January 2013 to December 2014 to study the renal transplanted patients for BK viremia and BKVAN. In our center patients received combination of de-sensitization therapy including antithymocyte globulin (ATG), rituximab (RITU), basiliximab, therapeutic plasma exchange, and methylprednisolone (MTP), in high risks or only MTP therapy in immunologically low risk patients.
  
  
  RESULTS
  Of total number of 26 patients (20-52 years, M/F 17/9), seven patients received ATG and seven patient received intensive desensitizing protocols, BKVAN and BK viremia happened in three and two patients in above groups subsequently, only one patient developed BKVAN in low risk group. We also observed; cytomegalovirus (CMV) and parvovirus B19 infection and hemophagocytic syndrome (HPS), thrombotic microangiopathy (TMA) and endocarditis in our patients with BKVAN and BK viremia.
  
  
  CONCLUSIONS
  Awareness about the possibility of BK virus nephropathy and appropriate immunosuppression minimization are crucial components of management. Consideration of other opportunistic infections and specific syndromes are also very important.
authors.affiliation: Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Haydarali
authors.initials: H
authors.lastname: Esmaili
authors.affiliation: Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran ; Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Elmira
authors.initials: E
authors.lastname: Mostafidi
authors.affiliation: Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Ardalan
authors.affiliation: Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran ; Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Vahedi
authors.affiliation: Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Fariba
authors.initials: F
authors.lastname: Mahmoodpoor
authors.affiliation: Pediatric Neurosurgery Unit, University of Alabama, Alabama, USA.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Mohajel-Shoja
keywords: BK virus; Hemophagocytic syndrome; Nephropathy; Thrombotic microangiopathy