Updated: 2/3/2019

BK Virus

Review Topic
  • A 45-year-old man presents to the emergency room for blood in his urine. He reports that he had a renal transplant 3 months ago and is currently on many immunosuppressive medications that he cannot name at the moment. He also reports dysuria and suprapubic pain. He denies having any fevers or chills. A urinalysis is positive for blood but is negative for nitrates or leukocyte esterase. He is started on intravenous fluids and admitted to the inpatient ward. A nucleic acid amplification test of his urine is positive for a polyomavirus. attempts are made to reach his transplant physicians to alter his immunosuppressive medications.
  • Classification
    • BK virus
      • a non-enveloped, circular, double-stranded DNA virus
      • a polyomavirus
      • causes
        • BK virus nephropathy
        • hemorrhagic cystitis
  • Epidemiology
    • risk factors
      • BK virus nephropathy
        • kidney transplant
      • hemorrhagic cystitis
        • hematopoeitic stem cell transplant
  • Pathogenesis
    • latent in uroepithelial cell and renal tubular cells
    • immunocompromised causes reactivation of the BK virus
  • Prognosis
    • in severe cases, renal graft may fail
  • Labs
    • elevated creatinine
    • nucleic acid amplification testing (NAAT) in blood or urine
  • Biopsy            
    • renal biopsy
      • definitive diagnosis of BK virus nephropathy
      • interstitial inflammation, intranuclear inclusion bodies in tubules
  • Acute renal allograft rejection        
    • distinguishing factor
      • elevated creatinine, new proteinuria, and oliguria
  • Management approach
    • reduction of immunosuppression medications if possible
    • some medications may be helpful, though there is no clear evidence for its use
      • cidofovir
      • leflunomide
  • Conservative
    • supportive care
      • modalities
        • hydration
        • bladder irrigation
  • Renal graft failure

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