BK polyomavirus nephropathy — ESENeph MCQ

Correct answer: C — Reduce immunosuppression with BK and graft monitoring

The best answer is “Reduce immunosuppression with BK and graft monitoring”. The BTS guideline identifies judicious immunosuppression reduction as the intervention with established clinical use, tailored to immunological risk and the current regimen. Viral load, creatinine and rejection risk are followed closely. “Give cidofovir as effective isolated first-line therapy while leaving immunosuppression unchanged” is less appropriate because no isolated antiviral has robust efficacy and ongoing immunosuppression drives viral replication “Increase tacrolimus to eliminate viral cytopathic change” is less appropriate because greater immunosuppression worsens BK replication and graft injury “Perform transplant nephrectomy before adjusting medication” is less appropriate because source control by nephrectomy is not first-line treatment for a functioning graft “Treat with high-dose methylprednisolone for presumed rejection” is less appropriate because the biopsy establishes BK nephropathy without concurrent rejection, and extra immunosuppression is hazardous

Reference: British Transplantation Society BK polyomavirus guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC11335089/