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BK Nephritis

The patient is a 45-year-old male with a past medical history significant for ESKD secondary to IgA nephropathy S/P renal transplant (3 years ago). He has been in his normal state of health but presented with an abnormal creatinine of 2.5 mg/dL on routine examination. His BK viral load was elevated at 25,000 copies in the serum. Figure 1 shows a normal glomerulus, figure 2 shows severe interstitial inflammation, figures 3 & 4 show marked tubulitis, and figure 5 shows a SV40 positive stain. This is a case of BK nephritis. BK virions are non-enveloped double-stranded DNA viruses. In immunohistochemistry,...

Art of Medicine: Polyomavirus Nephritis

The painting above shows acute tubular injury, reactive changes in tubular epithelial cells, tubulitis, inclusions within tubular epithelium, and interstitial inflammation.  These are morphologic changes that can be seen in polyomavirus nephritis.  BK virus is the most common etiology of polyomavirus nephritis, while JC virus and simian virus 40 (SV40) are less common etiologies.  All are DNA viruses that are non-enveloped and show tropism for the genitourinary tract, especially urothelium (Lusco et al, 2016).  Polyomavirus nephritis is a serious complication affecting approximately 5 to 6 percent of kidney transplants, often as a result of over-immunosuppression.  The prevalence is higher in...

BK Nephritis

This biopsy is from a patient with ESRD due to polycystic kidney disease. He is s/p deceased donor renal transplant 11 months prior to this biopsy. He was noted to have a steadily rising creatinine from baseline of 1.3 mg/dl up to 4.6 mg/dl at biopsy. Note the severe interstitial inflammation with nuclear atypia and severe arteriosclerosis (Figure 1, H&E 100x). There are markedly atypical nuclei including an apoptotic body (arrowhead) seen in the second image (Figure 2, 400x). The third image shows an SV40 IHC stain for polyoma virus that is positive in many nuclei (Figure 3, IHC SV40...

Pushing Glass (May 30, 2017)

A 62-year-old Asian male with a past medical history significant for ESRD secondary to hypertension S/P renal transplant (9 months ago) presents with a creatinine of 1.9 (baseline 1.2). The patient has had no previous episodes of rejection. The donor-specific antibody is negative. CMV, adenovirus and BK serology is pending. What is the best diagnosis? A. Acute Cellular Rejection, Banff Type 1B B. BK Nephritis C. Adenovirus D. Acute Antibody-Mediated Rejection The correct answer is B (BK nephritis). The low power trichrome picture shows patchy interstitial inflammation and fibrosis. The glomerulus has thickened capillary walls, but no definitive double contours...