Background: BK virus is highly seroprevalent but clinical disease typically occurs only in immunocompromised persons, most notably leading to significant morbidity in patients with kidney transplants. Less is known about the prevalence of BK nephropathy in other populations. We present two cases and a systematic review of the literature for biopsy-proven native kidney BK nephropathy.

Case 1: A 70 yo man with ICM underwent OHT with tacrolimus, MMF, and prednisone immunosuppression. Two years later, his serum creatinine (SCr) rose to 3.8 mg/dL over 5 months. Kidney biopsy showed tubular epithelial cells with focal glassy nuclear inclusions and positive nuclear staining for SV40 and Pab597. Serum BK PCR was 296,075 copies/ml. With stopping MMF, the serum BK viral load decreased and SCr stabilized at 3.5 mg/dL for approximately 3 years, at which point his SCr worsened. He progressed to ESRD and eventually died from malignancy.

Case 2: A 34 yo man with a PMH of non-Hodgkin`s lymphoma treated at age 18 with chemotherapy (CHOP regimen) was hospitalized for weakness and acute kidney injury (SCr 4.0 mg/dL, baseline 1.2 mg/dL). A kidney biopsy revealed tubular epithelial cells with intranuclear inclusions with positive nuclear staining on immunohistochemistry for polyoma virus. He was subsequently diagnosed with HLH and died of multi-organ system failure.

Methods: We searched MEDLINE and EMBASE and screened 651 papers. Two investigators independently selected papers based on predefined criteria and 47 papers were included in the systematic review.

Results: A total of 50 cases of biopsy-proven BK nephropathy in non-kidney transplant patients were found in the literature. In addition to the two we report, this brings the total to 52.

Discussion: Our systematic review of the literature has compiled the largest description of BK nephropathy to date outside of the kidney transplant population. BK nephropathy in the native kidney should be considered as a cause of renal injury in immunocompromised patients.

CITATION INFORMATION: Shah A., Kumar V., Laskin B., Sawinski D., Hogan J. BK Nephropathy in Non-Kidney Transplant Patients, a Case Series and Systematic Review of the Literature Am J Transplant. 2017;17 (suppl 3).

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