BK Virus Nephropathy — SCE Infectious Diseases MCQ

Correct answer: B — Reduce maintenance immunosuppression in a staged manner with close viral-load and graft-function monitoring with review

The best answer is “Reduce maintenance immunosuppression in a staged manner with close viral-load and graft-function monitoring with review”. Controlled immune reconstitution is the evidence-based core treatment; no antiviral has established routine curative efficacy and graft removal is not first-line. “Start ganciclovir because BK is a herpesvirus” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Use leflunomide as proven curative monotherapy” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Give full-dose cidofovir routinely despite nephrotoxicity” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Perform immediate graft nephrectomy before modifying immunosuppression” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement.

Reference: Second International Consensus Guidelines on BK polyomavirus: https://journals.lww.com/transplantjournal/fulltext/2024/09000/the_second_international_consensus_guidelines_on.7.aspx