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Polyomavirus associated nephropathy presenting five years after kidney transplantation
Malleshappa Pavan1, Ravi Ranganath, Anup P Chaudhari
1Department of Nephrology, Lilavati Hospital and Research Center, Bandra west, Mumbai, India. dr_pavanm@yahoo.co.in
Arab Journal of Nephrology and Transplantation
|October 18, 2011
Summary
Polyomavirus associated nephropathy (PVAN) can present late after kidney transplants. Early diagnosis via biopsy and adjusting immunosuppression can prevent graft loss.
Area of Science:
- Nephrology
- Transplant Immunology
- Virology
Background:
- Polyomavirus associated nephropathy (PVAN) is a significant cause of renal transplant dysfunction.
- Diagnosis requires a high index of suspicion due to its challenging nature.
- This case presents an unusually late manifestation of PVAN.
Observation:
- A 52-year-old male presented with elevated creatinine five years post-kidney transplant.
- Initial investigations including decoy cells and plasma PCR for BK virus DNA were negative.
- Kidney biopsy confirmed PVAN with positive SV40 immunohistochemistry.
Findings:
- Despite high tacrolimus levels and dose reduction, creatinine remained elevated.
- Withdrawal of mycophenolate mofetil temporarily resolved gastrointestinal symptoms.
- Discontinuation of tacrolimus and transition to azathioprine stabilized creatinine at 1.2 mg/dl.
Implications:
- PVAN can present significantly later than typically observed.
- Renal biopsy is crucial for accurate PVAN diagnosis.
- Prompt management, including immunosuppression adjustment, is vital for preserving kidney graft function.
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