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Updated: Feb 3 2019

BK Virus

  • Snapshot
    • 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.
  • Introduction
    • 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
  • Studies
    • 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
  • Differential
    • Acute renal allograft rejection
      • distinguishing factor
        • elevated creatinine, new proteinuria, and oliguria
  • Treatment
    • 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
  • Complications
    • Renal graft failure
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