Simultaneous BK Polyomavirus (BKPyV)-associated nephropathy and hemorrhagic cystitis after living donor kidney transplantation

Ilkka Helanterä; Hans H Hirsch; Marion Wernli; Fernanda Ortiz; Marko Lempinen; Anne Räisänen-Sokolowski; Eeva Auvinen; Laura Mannonen; Irmeli Lautenschlager

doi:10.1016/j.jcv.2015.12.008

Simultaneous BK Polyomavirus (BKPyV)-associated nephropathy and hemorrhagic cystitis after living donor kidney transplantation

J Clin Virol. 2016 Mar:76:4-7. doi: 10.1016/j.jcv.2015.12.008. Epub 2015 Dec 30.

Authors

Ilkka Helanterä¹, Hans H Hirsch², Marion Wernli², Fernanda Ortiz³, Marko Lempinen⁴, Anne Räisänen-Sokolowski⁵, Eeva Auvinen⁶, Laura Mannonen⁶, Irmeli Lautenschlager⁶

Affiliations

¹ Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, PO Box 372, FI 00029HUS, Helsinki, Finland. Electronic address: Ilkka.helantera@helsinki.fi.
² Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Petersplatz 10, CH-4009 Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
³ Department of Nephrology, University of Helsinki and Helsinki University Hospital, PO Box 372, FI 00029HUS, Helsinki, Finland.
⁴ Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, PO Box 372, FI 00029HUS, Helsinki, Finland.
⁵ Department of Pathology, University of Helsinki and Helsinki University Hospital (HUSLAB), PO Box 400, FI 00029HUS Helsinki, Finland.
⁶ Department of Virology, University of Helsinki and Helsinki University Hospital (HUSLAB), PO Box 400, FI 00029HUS, Helsinki, Finland.

PMID: 26771744
DOI: 10.1016/j.jcv.2015.12.008

Abstract

BK polyomavirus (BKPyV) commonly reactivates after kidney transplantation, and can cause polyomavirus-associated nephropathy (PyVAN), whereas after allogeneic stem cell transplantation the most frequent manifestation of BKPyV is polyomavirus-associated hemorrhagic cystitis (PyVHC). Despite high-level BKPyV replication in both, the pathogenesis and manifestation of both BKPyV entities appears to differ substantially. We describe an unusual case of simultaneous PyVAN and PyVHC presenting with acute symptoms in a BKPyV-IgG positive recipient eight months after kidney transplantation from a haploidentical living donor, who was BKPyV-IgG negative. Symptoms of cystitis and viremia subsided rapidly after reduction of immunosuppression.

Keywords: BK polyomavirus; Kidney transplantation; Polyomavirus-associated hemorrhagic cystitis; Polyomavirus-associated nephropathy.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cystitis / complications*
Cystitis / pathology
Cystitis / virology
Hemorrhage / complications
Hemorrhage / diagnosis
Hemorrhage / etiology
Hemorrhage / virology
Humans
Immunosuppression Therapy / adverse effects
Kidney Diseases / complications*
Kidney Diseases / diagnosis
Kidney Diseases / virology
Kidney Transplantation / adverse effects*
Living Donors
Male
Polyomavirus Infections / complications*
Polyomavirus Infections / diagnosis
Polyomavirus Infections / etiology
Polyomavirus Infections / virology
Postoperative Complications
Viremia