ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO845

BK Virus Nephropathy of Native Kidney After Hematopoietic Stem Cell Transplantation

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Hong, Ling, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong, China
  • Wang, Xiaodong, Shenzhen Children’s Hospital, Shenzhen, Guangdong, China
  • Wang, Lin, Guangzhou Kingmed Diagnostic Laboratory Ltd, Guangzhou, Guangdong, China
  • Wang, Ying, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong, China
  • Zheng, Zhihua, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong, China
  • Chen, Wenfang, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
Background

BK virus nephropathy (BKVN) is characterized by a tubulointerstitial injury caused by BK virus infection, which is more common after kidney transplantation. Few cases have been described outside the context of renal allograft. This study aims to elucidate the clinicopathologic features and prognosis of BKVN after hematopoietic stem cell transplantation (HSCT).

Methods

A total of 667 patients who received HSCT treatment at 2 centers from January 2020 to April 2022 were reviewed. The clinical characteristics, renal biopsy results, and prognosis of 7 BKVN patients were analyzed.

Results

The incidence of BKVN after HSCT was 1.0%, with a median age of 17 years and a median onset time of 12 months post-HSCT. The primary diseases were thalassemia major (5 cases) and acute lymphoblastic leukemia (2 cases). Haploidentical transplantation was performed in 6 patients (85.71%), and cord blood in1patient. Hemorrhagic cystitis occurred in 5 patients (71.43%) after HSCT. Proteinuria was absent or slight and a BK viral load >4 log copies/ml in blood in 7 cases, the median serum creatinine levels were 2.19mg/dl at the time of biopsy. Histologically, all cases showed tubulointerstitial inflammation while glomeruli were spared. Nuclear inclusion was detected in 5 cases (71.43%). There were 4 (57.14%) with severe tubular atrophy and interstitial fibrosis (IFTA), 2 (28.57%) were moderate and 1 (14.29%) mild; with AST stage B1(28.57%), B3(28.57%), C (42.86%). The SV40 T antigen was detected in tubular epithelial cells in 7 cases (100%). 5 (71.43%) were treated with cidofovir against BK infection, while 2 were given intensive immunosuppressive therapy for GVHD. 3 (42.9%) progressed to end-stage renal disease (ESRD) within 6 months after renal biopsy, among which 2 was AST stage C and 1 was stage B1.

Conclusion

Patients who undergo HSCT, especially haploid transplantation, may develop BK virus infection, initially presenting as high levels of BK viruria or BK viremia and then progressing to BKVN, which will result in ESRD.