대한신장학회

논문분류
제목	Experience of Treatment of Severe Crescentic BK Nephropathy
저자	In O Sun, Byung Sun Kim, Woong Ki Lee, Hye Mi Choi, Choong Sil Seong,Hyeuk Soo Lee, Hyun Ju Yoon, Jeong Gwan Kim, Kwang Young Lee
출판정보	2014; 2014(1):
키워드	반월상, BK 바이러스
초록	Introduction: In case of severe BK virus associated nephropathy, infection of the glomerular epithelium cell can infrequently occur, which develop most often in biopsy with high viral load in tubular epithelium. We report an unusual case of BKVAN with crescent formation, which was treated by intensive strategy including reduction of immunosuppressant, leflunomide, ciprofloxacin and intravenous immunoglobulin. Case Report: A 44-year old man was admitted for evaluation of asymptomatic graft dysfunction (serum creatinine level was 2.2 mg/dL). He had maintained a stable serum creatinine level (0.9-1.3 mg/dL). Polymerase chain reaction (PCR) assays of urine and serum samples showed that BK urine viral load was elevated significantly, 5.0×108 copies/ mL, and the serum viral load was 7.9×107 copies/mL. An allograft biopsy was performed on the day of admission. The biopsy specimen revealed diffuse interstitial infiltration of lymphocyte (i3) with moderate tubulitis (t3) and SV 40 positive renal tubular epithelial cells. Moreover, there were evident cytopathic changes in the epithelial parietal cells of the Bowman’s capsule, or piled up to form cellular crescent in 2 glomeruli. Based on these findings, the patient was diagnosed with BK virus nephropathy, and then, immunosuppression was modified by discontinuing mycophenolate and reducing the tacrolimus (3-5 ng/mL). Leflunomide treatment was also started simultaneously, at a loading dose of 60 mg/day for 3 days, followed by a daily maintenance dose of 20 mg. However, the serum creatinine increased up to 3.0 mg/dL on day 14, therefore, the patient underwent second allograft biopsy, in which crescent was no longer evident, whereas tubulitis (t2) and fibrosis (i2) persist. On day 20, we changed leflunomide to ciprofloxacin due to lekopenia. Although these treatment, the serum creatinine increased up to 3.3 mg/dL, thus, 3rd biopsy was done on day 38. Comparing previous allograft biopsy, the third biopsy showed slightly improved tubulitis and interstitial inflammation. For further improvement, we decided to administrate the intravenous infusion of immunoglobulin at a dose of 2 g/kg divided for 5 days. After such therapy, the renal function of the patient was stable (serum creatinine 2.8 mg/dL), and the BK serum viral load was low on day 70, and the patient discharged. Eight months after treatment of BKVAN, the renal function remained unchanged (serum creatinine 3.2 mg/dL).
원문(PDF)	PDF 원문보기

간행물 검색

대한신장학회 회원관리 규정