Native BK Polyomavirus Nephropathy in an Orthotopic Heart Transplant Patient

Authors

Zachary M Thompson
George Ajene
Prathit A Kulkarni
Nidhi Aggarwal
Savitri Fedson
Maulin K Shah

Publication Date

1-1-2023

Journal

Journal of Investigative Medicine High Impact Case Reports

DOI

10.1177/23247096231184770

PMID

37394803

PMCID

PMC10328171

PubMedCentral® Posted Date

7-2-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Male, Humans, Aged, BK Virus, Kidney, Kidney Transplantation, Nephritis, Interstitial, Heart Transplantation, Polyomavirus Infections, polyomavirus nephropathy, BK nephropathy, heart transplant

Abstract

BK polyomavirus nephropathy (BKVN) is a common cause of nephropathy in kidney transplant patients and is typically seen within the first year after transplantation. BK polyomavirus nephropathy can occur in the native kidneys of patients with nonrenal solid-organ transplants (NRSOT). However, this is rare, especially outside the early post-transplant period, and BKVN is not usually considered in the differential diagnosis for acute kidney injury in NRSOT patients. We present a case of a 75-year-old man who had undergone orthotopic heart transplant 13 years prior with stable allograft function who developed progressive renal dysfunction in the setting of recent unilateral obstructive nephrolithiasis requiring ureteral stenting. Kidney biopsy demonstrated evidence of polyomavirus nephritis. Serum BK viral load was elevated. Despite reducing immunosuppression and initiating leflunomide, viral clearance was never achieved. The patient experienced progressive failure to thrive before ultimately transitioning to hospice care and dying. The intensity of immunosuppression is a well-known risk factor for viral replication; ureteral stenting has also been associated with BKVN. However, since clinical manifestations of BK viral infections often include a genitourinary (GU) tract pathology, it is important for clinicians to consider BKVN in patients with NRSOT with progressive renal dysfunction, especially in the clinical context of known GU disease.