Kidney Week

Abstract: SA-PO1144

Adenovirus Nephritis with BK Virus Nephropathy After Deceased Donor Kidney Transplantation: A Case Report

Session Information

• Transplantation: Clinical - Infectious Diseases
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Kim, Yanghyeon, Bongseng Memorial Hospital, Busan, Korea (the Republic of)

Yanghyeon Kim, MD

• Lee, A Rim, Bongseng Memorial Hospital, Busan, Korea (the Republic of)

A Rim Lee, DO, DrMed, DrPH

• Yi, Jiyae, Bongseng Memorial Hospital, Busan, Korea (the Republic of)

Jiyae Yi, MD

• Kim, Hee yeoun, Bongseng Memorial Hospital, Busan, Korea (the Republic of)

Hee yeoun Kim, MD

• Ahn, Jeongmyung, Bongseng Memorial Hospital, Busan, Korea (the Republic of)

Jeongmyung Ahn, MD

• Oh, Joon Seok, Bongseng Memorial Hospital, Busan, Korea (the Republic of)

Joon Seok Oh, MD, PhD

• Kim, Joong Kyung, Bongseng Memorial Hospital, Busan, Korea (the Republic of)

Joong Kyung Kim, MD

• Kim, Yong-Jin, Kyungpook National University, Daegu, Korea (the Republic of)

Yong-Jin Kim, MD, PhD

Introduction

Post-kidney transplant adenovirus nephritis is a rare but potentialy serious condition associated with acute alograft dysfunction, and evidence regarding its management remains limited.

Case Description

We report the case of a 44-year-old man who underwent deceased donor kidney transplantation. He had previously received a living donor kidney transplant from his mother at the age of 18 but returned to dialysis at 31 due to recurrent IgA nephropathy. At 44, he received a second kidney transplant from a deceased donor. A 1-hour perfusion protocol biopsy confirmed IgA deposition. Four months after transplantation, the patient presented with gross hematuria, dysuria, and fever lasting one day. His serum creatinine increased from 1.29 mg/dL to 2.6 mg/dL. Proteinuria progressed from negative to a urine protein-to-creatinine ratio (uPCR) of 1.99, and serum BK polyomavirus PCR revealed a viral load exceeding 5 log copies/mL. Despite empirical antibiotic treatment, his symptoms worsened. A renal alograft biopsy demonstrated necrotizing granulomatous interstitial nephritis, suggesting adenoviral infection, with concurrent findings of BK nephropathy and IgA deposition (Figure 1). Adenovirus was also detected in both the serum and respiratory tract. The patient was treated with reduced immunosuppression and ganciclovir. Clinical improvement was noted within two weeks. Approximately three months after treatment, the patient remained in good health. Resolution of proteinuria and hematuria was observed, folowed by negative conversion of both serum adenovirus and BK virus PCR. Serum creatinine stabilized at 1.5 mg/dL.

Discussion

Adenovirus nephritis is an increasingly recognized complication in adult kidney transplant recipients. It presents with varied clinical manifestations and poses diagnostic chalenges. Although rare, it has significant implications for alograft function. Kidney biopsy plays a crucial role in establishing the diagnosis. Treatment strategies include reduction of immunosuppression, antiviral therapy, and, in some cases, intravenous immunoglobulin. The clinical course was relatively favorable with appropriate intervention.

A) Necrotizing granulomatous interstitial nephritis
B) BK virus nephropathy
C) Viral particles in tubule cells