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KMID : 1235920120040010016
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Medical Journal of Catholoc University of Daegu
2012 Volume.4 No. 1 p.16 ~ p.21
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A Case of BK Virus Nephropathy Improved by Combination Therapy Including Intravenous Immunoglobulin, Leflunomide, Ciprofloxacin and Cidofovir in the Kidney Transplant Recipient
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Lee In-Hee
Park Kwan-Kyu
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Abstract
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Although BK virus nephropathy (BKVN) has been recognized as a significant cause of allograft dysfunction or failure in kidney transplantation, there is no established therapeutic guideline. Here we report a case of BKVN improved by combined therapy including intravenous immunoglobulin (IVIG), leflunomide, ciprofloxacin, and cidofovir, along with a reduced immunosuppression. A 20-year-old female, who had received a renal transplant from a cadaver 8 months ago, was admitted to our hospital with a rise in serum creatinine (Cr) level from 0.8 mg/dL to 2.2 mg/dL over the preceding 2 months while on an immunosuppression with tacrolimus, mycophenolate mofetil (MMF), and prednisolone. An allograft biopsy demonstrated a patchy inflammatory infiltrate with edema and tubulitis, suggestive of BKVN. MMF was stopped, tacrolimus was continued at lower dose (4 mg per day), and IVIG was started. And then leflunomide, ciprofloxacin, and low dose cidofovir therapy were instituted. Her renal function remained stable throughout follow-up periods, with serum Cr level of 1.8-2.0 mg/dL. She remained free of BKVN with serum Cr level of 1.8 mg/dL at 26 months post-transplantaion.
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KEYWORD
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BK virus nephropathy, Transplantation
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