skip to main content

BKVAN Management — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNephrologyBKVAN ManagementRACP Adult Medicine

A 45-year-old renal transplant recipient (1 year post-transplant) develops rising creatinine and haematuria. Tacrolimus level is 12 μg/L (slightly above target). Urine BK virus PCR is strongly positive (>10⁷ copies/mL). Plasma BK virus is 10⁵ copies/mL. Transplant biopsy shows characteristic viral cytopathic changes (decoy cells, intranuclear inclusions) consistent with BK virus-associated nephropathy (BKVAN). What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — IV methylprednisolone 500 mg daily for 3 days

BKVAN requires REDUCTION of immunosuppression (not treatment of rejection). The mainstay is: reduce tacrolimus target (to 4-6 μg/L) and/or reduce/cease MMF. There is no specific antiviral treatment for BK virus. Cidofovir and leflunomide have been used but evidence is limited. IVIG may help. Differentiation from rejection is critical — both present with rising creatinine but management is opposite (immunosuppression increase vs decrease). [Note: option B best-fit is suboptimal; clinical answer is reduce immunosuppression]

Reference: KDIGO – 2024 – BK Nephropathy; TSANZ 2024