Nephroquiz 4: A 43-Year-Old Woman With Kidney Allograft Dysfunction Due to BK Virus Nephropathy

A 43 years-old woman was admitted to hospital because of kidney allograft dysfunction. She had received a living kidney donation 8 months earlier, after 5 months of hemodialysis, and the early posttransplant course was excellent. The cause of her kidney failure was unknown, but her kidneys were bilaterally small with no extrarenal presentations. Her serum creatinine was 1.5 mg/dL 1 month earlier, but rose to 2.4 mg/dL. There were no complaints of febrile episodes, cough, dyspnea, diarrhea, or localized pain. Blood pressure was 140/80 mm Hg, and physical examination was unremarkable expect for mild pedal edema. Her drug history was cyclosporine A, 200 mg/d, mycophenolate mofetil, 2 g/d, and prednisolone, 10 mg/d. Laboratory data were as follows: hemoglobin, 13 g/dL; platelet count, 240 × 109/L; leukocyte count, 8.5 × 109/L; blood urea nitrogen, 32 mg/dL; serum creatinine, 2.4 mg/dL; serum sodium, 141 mmol/L; serum potassium, 4.8 mmol/L; fasting blood glucose, 68 mg/ dL; serum uric acid, 5.8 mg/dL; creatine phosphokinase, 180, U/L; serum calcium, 8.8 mg/dL; serum phosphate, 4.3 mg/dL; serum alanine transferase