Photo Quiz - February 2018

A 55 year old female who had undergone renal transplantation 3 months earlier presented with macroscopic hematuria and increased urinary frequency for 3 days. She was on mmf 600/Tac7mg/pred12.5mg/septran SS 1OD. Stent removal had been done at one month and there was no rexploration/rejection.

Labs showed a leucocyte count of 7700 cells/ul (N76/L16), Cr 1.1, Urine routine - pus cells 10 and RBCs - plenty. Urine culture was sterile.

CT KUB of transplant kidney showed a patchy area of hyperenhancement in upper pole, thickened pelvi-calyceal system with urothelial enhancement.

Figure 1: CT KUB

What is your diagnosis? View Answer

Answer

BK viral load in blood was 1,79,000 copies/ml. The patient’s symptoms improved and viral load fell after reduction of immunosuppression.

BK virus is a cause of renal dysfunction and disease of the collecting system of the transplant kidney post transplant. It is especially likely in a D+ R- situation in the presence of high level immune suppression.

Final diagnosis: BK virus nephropathy post renal transplant

Case provided by: Dr Kalpesh Sukhwani