Therapeutic options in BK virus-associated interstitial nephritis

A female in her 30s developed renal failure secondary to mixed connective tissue disease-associated immune complex glomerulonephritis. Her past medical and family history was otherwise unremarkable. She underwent a pre-emptive renal transplantation from her mother, receiving induction with dacluzimab and had an uneventful post-transplant course. Her immunosuppressive regimen at discharge included prednisone 5mg daily, mycophenolate mofetil 1000mg twice daily, tacrolimus 4mg twice daily, and prophylaxis with oral gancyclovir and trimethoprim - sulfamethoxazole, atenolol for hypertension, and famotidine, iron and calcium/vitamin D supplements. Her baseline serum creatinine after the transplant was 1.5mg/dl. Two years after receiving the transplant, she developed fever and dysuria and was treated for a presumed urinary tract infection ( negative urine cultures). Her serum creatinine during this episode increased to 1.9mg/dl and remained elevated in this range. Her physical examination was unremarkable and her blood pressure was 130/80mm Hg. A renal ultrasound did not show any abnormalities. A renal biopsy was performed.