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Case Reports
. 2021 Jul-Sep;43(3):434-439.
doi: 10.1590/2175-8239-JBN-2020-0049.

BK virus nephropathy in a heart transplant recipient

[Article in English, Portuguese]
John Fredy Nieto-Ríos  1   2 , Diego Armando Benavides-Henao  2 , Arbey Aristizabal-Alzate  1 , Carol Morales-Contreras  2 , Diana Carolina Chacón-Jaimes  2 , Gustavo Zuluaga-Valencia  1 , Lina María Serna-Higuita  3
Affiliations
Case Reports

BK virus nephropathy in a heart transplant recipient

[Article in English, Portuguese]
John Fredy Nieto-Ríos et al. J Bras Nefrol. 2021 Jul-Sep.

Abstract
in English, Portuguese

BK virus nephropathy in kidney transplantation is widely recognized as an important cause of graft dysfunction and loss. In the case of transplants of organs other than kidney, BK virus nephropathy in native kidneys has been recognized as a cause of chronic kidney disease, which is related with immunosuppression; however, the diagnosis is usually late because the renal dysfunction is attributed to other causes, such as toxicity by anticalcineurinic drugs, interstitial nephritis due to medications, hemodynamic changes, diabetes, hypertension, etc. We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The kidney biopsy reported active chronic tubulointerstitial nephritis associated with late stage polyomavirus nephritis and the blood viral load for BK virus was positive (logarithm 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with a serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2). We recommend that the BK virus be considered as a cause of renal dysfunction in heart transplant recipients, with the aim of detecting its replication in time to reduce immunosuppressive therapy before irreversible compromise of renal function may manifest.

A nefropatia pelo vírus BK no transplante renal é amplamente reconhecida como uma importante causa de disfunção e perda do enxerto. No caso de transplantes de órgãos que não sejam rins, a nefropatia pelo vírus BK em rins nativos tem sido reconhecida como uma causa de doença renal crônica, que está relacionada com imunossupressão; entretanto, o diagnóstico é geralmente tardio porque a disfunção renal é atribuída a outras causas, tais como toxicidade por drogas anticalcineurínicas, nefrite intersticial devido a medicamentos, alterações hemodinâmicas, diabetes, hipertensão, etc. Relatamos um caso de nefropatia pelo vírus BK em um paciente que foi submetido a transplante cardíaco devido à cardiomiopatia periparto. A biópsia renal relatou nefrite túbulo-intersticial crônica ativa associada à nefrite por poliomavírus em estágio avançado e a carga viral sanguínea para o vírus BK foi positiva (logaritmo 4,5). O tratamento imunossupressor foi reduzido, e após dois anos de acompanhamento, o paciente apresentava função renal estável com creatinina sérica de 2,5 mg/dL (TFG de 23,4 mL/min/1,73m2). Recomendamos que o vírus BK seja considerado como uma causa de disfunção renal em receptores de transplante cardíaco, com o objetivo de detectar sua replicação a tempo de reduzir a terapia imunossupressora antes que um comprometimento irreversível da função renal possa se manifestar.

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Conflict of interest statement

Conflict of interest

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Laboratory values during follow up.
Figure 2
Figure 2. BK viral load (number of copies).
Figure 3
Figure 3. Renal biopsy report: active chronic tubulointerstitial nephritis, with positive immunohistochemistry for SV40, consistent with stage C polyomavirus nephritis (arrows). Image courtesy of Department of Pathology, Fundación Santa Fe de Bogotá, Colombia.
See this image and copyright information in PMC

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