BRCU 2026: Test Your Knowledge
A 35-year-old man with a history of ESKD thought to be secondary to diabetic kidney disease received a living donor kidney transplant 4 months ago. His blood type is B and the donor's is A2. He received anti-thymocyte globulin induction therapy and currently is taking tacrolimus 1 mg twice daily, mycophenolate mofetil 1000 mg daily, and prednisone 5 mg daily. His nadir creatinine was 1 mg/dL last month, and today is up to 3 mg/dL. He feels well today and does not have any symptoms. A tacrolimus trough is 8 ng/mL. He does not have any anti-HLA antibodies. A kidney biopsy is performed and reveals acute interstitial nephritis and tubulitis. Glomeruli and peritubular capillaries appear normal. Immunohistochemistry stains for both C4d and SV40 are positive.
Which of the following is the next best step?
- Initiate intravenous immunoglobulin and high-dose steroids
- Initiate alemtuzumab
- Initiate bortezomib
- Decrease tacrolimus
- Decrease mycophenolate mofetil
- Decrease prednisone
References
- Kant S, Dasgupta A, Bagnasco S, Brennan DC. "BK Virus Nephropathy in Kidney Transplantation: A State-of-the-Art Review." Viruses 14, no. 8 (2022):1616. doi: 10.3390/v14081616
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