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Kidney Week

Abstract: TH-PO139

A Case of BK Nephropathy in a Newly Diagnosed HIV Patient

Session Information

Category: Trainee Case Report

  • 103 AKI: Mechanisms

Authors

  • Tubio, Lesley anne Guevara, Makati Medical Center, Malate, Philippines
  • Ferrer, Filoteo, Makati Medical Center, Malate, Philippines
Introduction

BK virus-related nephropathy has been reported more among post-transplant patients with immunosuppressive therapy but is less identified among non-transplant and HIV patients.

Case Description

We report at 52-year-old male, admitted due to chronic cough. He was incidentally found to be Human Immunodeficiency Virus (HIV) positive with CD4 254 cells/µL and was empirically treated for possible Pulmonary Tuberculosis (PTB) reactivation and Pneumocystis pneumonia (PCP). During his hospital stay, his serum creatinine (sCr) was noted to be increasing reaching level of 3.82 mg/dL (from baseline of 0.82 mg/dL one year prior). He was then dialyzed and underwent kidney biopsy which showed minor glomerular abnormalities, acute interstitial nephritis with acute tubular injury, mild interstitial fibrosis and tubular atrophy with 6% global glomerulosclerosis. Trial of steroids was given and was started on antiretrovirals (ARVs). His kidney function stabilized without dialysis support over the next two months.

Persistence of non oliguric acute kidney injury incompatible with his seemingly stable clinical state prompted further investigation, trial of drug holiday (off ARVs), and a repeat kidney biopsy was done. Results showed acute interstitial nephritis with acute tubular injury, moderate interstitial fibrosis and tubular atrophy with 20% global glomerulosclerosis; additional SV 40 stain was requested and showed positive results – supportive of BK nephropathy (BKN). Previous biopsy tissue was reviewed and re-examined. SV40 stain was requested and patient was already positive for SV40 stain. BK virus load was at 262,577 copies/mL and was placed on trial of fluoroquinolone.

Patient’s renal function no longer recovered with peak sCr of 18.65 mg/dL, is currently maintained on intermittent hemodialysis, and ARVs were resumed.

Discussion

This is an interesting case of a biopsy-proven BK nephropathy in a native kidney of a newly diagnosed HIV patient with a CD4 count of more than 200 cells/µL. Most published data on BK nephropathy in HIV patients have CD4 of less than 50 cells/µL. BKN may be considered as a differential diagnosis in HIV or immunocompromised patients with progressive renal failure.