BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

Table 1 BK infection studies in organ transplants other than solitary kidney transplants

Transplanted organ	Ref.
Bone marrow, stem cells	[2,5,8,39-81]
Heart	[11,82-96]
Lung	[97-102]
Liver	[103-113]
Pancreas, combined pancreas-kidney	[114-135]

Table 2 BK nephropathy in recipients of bone marrow or stem cell transplants

Ref.	Gender age	Renal function	Clinical associations
[8]	Female 36 yr	ESRD Dialysis	Relapsed Hodgkin’s lymphoma
[8]	Female 43 yr	ESRD Dialysis	Acute myelogenous leukemia
[11]	Male 47 yr	ESRD Dialysis	Non-Hodgkin’s lymphoma
[49]	Male 17 yr	ESRD Dialysis	Myelodysplastic syndrome Severe hemorrhagic cystitis No renal biopsy Death from multi-organ failure
[50]	Female 28 yr	ESRD Dialysis	Acute myelogenous leukemia Recurrent CMV reactivation
[51]	NR NR	ARF	Underlying disease NR Adenovirus pneumonia Adenovirus nephritis Death
[58]	Male 14 yr	Rising SCr	Acute myelogenous leukemia Death from multi-organ failure
[60]	Male 10 yr	GFR normalized	Acute myelogenous leukemia No renal biopsy
[63]	Male 51 yr	ESRD Dialysis	Myelodysplastic syndrome Hepatorenal syndrome GVHD Death from Pseudomonas sepsis
[64]	Male 10 yr	Peak SCr 3.5 mg/dL Scr at 1.7 mg/dL post-treatment	Chronic myelogenous leukemia Adenovirus and bacterial infections Severe GVHD
[64]	Male 13 yr	ESRD Declined dialysis	Fanconi’s anemia Gram-positive bacteremias Pulmonary aspergillosis Hyperacute GVHD Death
[70]	Female 10 yr	ESRD Dialysis	Recurrent metastatic neuroendocrine tumor Thrombocytopenia, leukopenia, lymphopenia Antineutrophil-antiplatelet antibodies Death from sepsis
[75]	Female 10 yr	Peak SCr 1.58 mg/dL SCr at 1.1-1.4 mg/dL post-treatment	Myelodysplastic syndrome Acute GVHD
[77]	Male 59 yr	CKD stage 5 not requiring dialysis	Myelodysplastic syndrome
[79]	Male 58 yr	Death due to sepsis eGFR stable at 20 at the time of death	Large B cell lymphoma Acute GVHD

BK nephropathy was manifested at various times post-heart transplantation. Ages reported in this Table are the calculated ages at the time of diagnosis of BK nephropathy. ESRD: End-stage renal disease; ARF: Acute renal failure; SCr: Serum creatinine; GFR: Glomerular filtration rate; GVHD: Graft vs host disease; NR: Not report.

Table 3 BK Nephropathy in heart transplant recipients

Ref.	Gender age	Renal function	Clinical associations
[11]	Male, 65 yr	ESRD Refused dialysis	No rejection episodes Urothelial transitional cell carcinoma causing bilateral hydronephrosis Death following perforated gastric ulcer
[84]	Female 59 yr	SCr 5.0 mg/dL Awaiting dialysis	Three severe rejection episodes early
[85]	Male 57 yr	ESRD On dialysis	Repeated rejection episodes
[86]	Male 26 yr	ESRD On dialysis	Multiple rejection episodes
[89]	Male 54 yr	ESRD Dialysis	Persistent rejection Death from arrhythmia
[90]	Male 12 yr	Last SCr 2.0 mg/dL	Cardiomyopathy from chemotherapy for Ewing’s sarcoma One rejection episode
[91]	Male 8 yr	ESRD On dialysis	8 rejection episodes in 1st heart transplant BK nephropathy after 2nd heart transplant
[93]	Female 9 yr	Peak SCr 1.9 mg/dL Last SCr 1.2 mg/dL	Rejection episodes not reported Reduction in BK viral load and improvement in renal function after leflunomide was started
[94]	Male 14 yr	ESRD Dialysis	Multiple rejection episodes Lymphoproliferative disorder in the 12th year BK nephropathy in the 16th year Death from multiple organ failure
[96]	Male 60 yr	ESRD On peritoneal dialysis	One rejection episode
[96]	Male 43 yr	eGFR 40 mL/min	Recurrent giant cell myocarditis in the transplanted heart One rejection episode

BK nephropathy was usually manifested several years post-heart transplantation. Ages reported in this Table are the calculated ages at the time of diagnosis of BK nephropathy. ESRD: End-stage renal disease; SCr: Serum creatinine; eFGR: Estimated glomerular filtration rate.

Table 4 BK nephropathy in recipients of lung, liver and pancreas transplantation

Ref.	Gender age	Renal function	Clinical associations
Lung
[98]	Male 40 yr	ESRD On dialysis	Metastatic seminoma treated successfully Three rejection episodes
[101]	Female 72 yr	Peak SCr 2.6 mg/dL Last SCr 2.2 mg/dL	Prolonged neutropenia post-transplant No rejection episodes
[102]	Male 9 yr	ESRD Dialysis	Collecting duct carcinoma Death from respiratory and cardiac failure
Liver
[112]	Male 59 yr	SCr 1.9 mg/dL at diagnosis	Multiple rejection episodes Follow-up after diagnosis not reported
Pancreas
[114]	Male 54 yr	SCr 2.2 mg/dL At diagnosis	Follow-up after diagnosis not reported

ESRD: End-stage renal disease; SCr: Serum creatinine.

Table 5 Clinical manifestations of BK virus infection

Uropoietic system

Nephropathy

Hemorrhagic cystitis

Ureteritis - ureteral obstruction

Respiratory system

Upper respiratory infection

Pneumonia

Central nervous system

Meningoencephalitis

Progressive multifocal leukoencephalopathy (probable)

Retinae

Retinitis

Progressive outer retinal necrosis (questionable)

Blood vessels

Vasculitis

Gastrointestinal system

Intestinal ulcers

Lower gastrointestinal bleeding

Hematopoietic system

Pancytopenia

Neutropenia

Hemophagocytic syndrome

Polyclonal gammopathy

Malignancies

Urothelial tumors

Various other tumors