BK polyoma virus infection and renal disease in non-renal solid organ transplantation

Abstract

BK virus (BKV) is a non-enveloped DNA virus of the polyomaviridae family that causes an interstitial nephritis in immunosuppressed patients. BKV nephropathy is now a leading cause of chronic kidney disease and early allograft failure following kidney transplantation. It is also known to cause renal disease with a progressive decline in kidney function in non-renal solid organ transplant (NRSOT) recipients, although the disease may not be recognized nor its impact appreciated in this patient population. In this report, we review the existing literature to highlight our current understanding of its incidence in NRSOT populations, the approaches to diagnosis and the potential treatment options.

Keywords: BK polyoma virus; immunosuppression complication; interstitial nephritis; non-renal solid organ transplantation.

Fig. 1.

Polyomavirus nephropathy in a lung transplant recipient. (A) Hematoxylin & Eosin stain. Interstitial inflammation with mononuclear, lymphocyte and plasma cells, and areas of tubulitis (arrowheads): mononuclear and lymphocyte inflammatory cells damaging epithelium of the renal tubules. Viral cytopathic changes including nuclear atypia, vesicular changes, and finely granular and coarsely clumped inclusions (black arrow) are shown. (B) Positive (tan-brown) SV-40 large T antigen (polyomavirus) immunohistochemical stain in nuclei of tubular epithelial cells.