skip to main content

Renal papillary necrosis — ESENeph MCQ

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

HardUrological ConditionsRenal papillary necrosisESENeph

Seven months after kidney transplantation, a patient has rising creatinine. Plasma BK viral load has increased on two samples and biopsy shows SV40-positive tubulointerstitial nephritis. What is the central management intervention?

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

Reveal the answer and explanation

Correct answer: B — Lower antimetabolite and calcineurin-inhibitor exposure with serial BK PCR

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

E is correct. The cornerstone of management for BK polyomavirus nephropathy is carefully staged reduction of immunosuppression, commonly beginning with the antimetabolite and/or calcineurin-inhibitor exposure according to the transplant protocol. Viral load and graft function are followed closely because undertreatment risks progressive viral injury while excessive reduction risks rejection. SV40-positive tubulointerstitial inflammation can resemble rejection, so reflex corticosteroid escalation may worsen viral replication. No antiviral agent has evidence sufficient to replace immunosuppression reduction as the principal intervention.

Reference: UK Kidney Association post-operative care in the kidney transplant recipient: https://www.ukkidney.org/health-professionals/guidelines/post-operative-care-kidney-transplant-recipient