Table 1 Summary of all reported cases of BK virus-associated nephropathy in lung transplant recipients including the present case
From: BK virus-associated nephropathy in a lung transplant patient: case report and literature review
Author and year | Age at transplant Gender | Indication for transplant | Onset of renal dysfunction (months post-transplant) Creatinine at disease onset (μmol/l) | BKV PCR in urine and blood at diagnosis | Biopsy | Management | Outcome |
|---|---|---|---|---|---|---|---|
Schwarz et al. 2005 [15] | 38 years Male | Pulmonary fibrosis due to chemotherapy for seminoma | 15 months 227 μmol/l | Urine: + >  100,000,000 Geq/ml Blood: + 117,500 Geq/ml | Positive | Immunosuppression not reduced due to recent rejection, hence cidofovir used, then leflunomide in place of cidofovir due to improved biopsy results | Repeat renal biopsy performed three months after original diagnostic biopsy and one month after a course of cidofovir showed absence of BKVAN changes (with BKV PCR in blood also showing significant reduction) with further subsequent improvement on leflunomide, however renal function nonetheless deteriorated and RRT was required |
Egli et al. 2010 [16] | 67 years Female | COPD | 63 months 183 μmol/l | Urine: + > 100,000,000 Geq/ml Blood: + 71,000 Geq/ml | Positive | ↓ immunosuppression, leflunomide (but was ceased at 3 months for diarrhoea / anaemia) | Stabilisation of creatinine (peak was at 237 μmol/l improving to 190 μmol/l) and undetectable BKV PCR in blood (still positive in urine) at 1 year post-diagnosis |
Dufek et al. 2013 [17] | 8 years Male | Bronchiolitis obliterans | 12 months N/A | Urine: >  100,000,000 Geq/ml Blood: + > 100,000,000 Geq/ml | Positive | Haemodialysis, switch of mycophenolate for everolimus, ↓ tacrolimus and prednisolone, intravenous cidofovir | Development of rapidly progressive, ultimately fatal, collecting duct carcinoma with strong positivity for SV40 antibody staining in the nuclei of tumour cells |
Sharma et al. 2013 [18] | 30 years Male | Cystic fibrosis | 24 months 195 μmol/l | Urine: N/A Blood: + 3,500,000 Geq/ml | Positive | Leflunomide commenced and mycophenolate ceased | Increase then stabilisation of creatinine at 274 μmol/l at 20 months post-diagnosis |
Vigil et al. 2016 [19] | 70 years Male | IPF | 24 months 265 μmol/l | Urine: N/A Blood: + 10,000,000 Geq/ml | Positive | Mycophenolate was ceased, tacrolimus and prednisolone continued, leflunomide started and three doses of IVIG given | Improvement in BKV PCR in blood and stabilisation of creatinine at 250 μmol/l |
Kuppachi et al. 2017 [20] | 63 years Male | COPD | 24 months 230 μmol/l | Urine: N/A Blood: + 87,900 Geq/ml | Positive | Azathioprine ceased, ↓ tacrolimus, leflunomide commenced | Initial good response with reduction in BKV PCR in blood and stabilisation of renal function at 265 μmol/l, but then was found to have locally-advanced prostate carcinoma and separate metastatic urothelial carcinoma (two separate primary malignancies) which rapidly advanced in parallel with drastic increases in BKV PCR counts |
Okumura et al. 2019 [21] | 30 years / 44 years Female | LAM/relapsed LAM | 3 months 66 μmol/l | Urine: + > 100,000,000 Geq/ml Blood: + 800 Geq/ml | N/A | ↓ immunosuppression to standard maintenance levels post-transplant, and addition of sirolimus at six months post-transplant | Gradual improvement in renal function and reduction in BKV PCR in blood, with levels falling to undetectable levels at 5 months post-diagnosis |
Present case 2020 | 57 years Male | COPD | 9 months 184 μmol/l | Urine: + >  10,000,000 Geq/ml Blood: + 358,000 Geq/ml | Positive | ↓ immunosuppression, change of mycophenolate to everolimus, and then IVIG when renal function deteriorated further | Gradual deterioration in renal function despite these measures, requiring fistula formation for the planned commencement of haemodialysis |