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BK Nephropathy — ESENeph MCQ

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ModerateTransplantationBK NephropathyESENeph

A 39-year-old woman is 6 months post-kidney transplant on Tacrolimus 4 mg BD, Mycophenolate 750 mg BD, and Prednisolone 5 mg. She is found to have a positive BK virus PCR in blood at 12000 copies/mL. Her creatinine is stable at 110 umol/L. What is the most appropriate first step?

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Correct answer: C — Reduce immunosuppression (decrease Mycophenolate first)

BK viraemia >10,000 copies/mL indicates presumptive BK nephropathy risk. KDIGO 2009 transplant guideline recommends reducing immunosuppression as first-line management. Typically, Mycophenolate is reduced first (or stopped), followed by Tacrolimus dose reduction if viraemia persists. There is no approved antiviral for BK virus. Transplant biopsy is indicated if creatinine rises or viraemia persists despite immunosuppression reduction. Cidofovir and leflunomide have been used but lack robust evidence.

Reference: KDIGO 2009 – Transplant Guideline; BK Virus in Kidney Transplantation – Lancet Review 2021