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End-stage renal disease due to polyomavirus in a cardiac transplant patient

Nature Clinical Practice Nephrology volume 3, pages 393–396 (2007)Cite this article

Abstract

Background A 51-year-old male orthotopic cardiac transplant recipient experienced a prolonged rejection episode immediately after transplantation. Three years and 5 months after transplantation, he presented with lower extremity swelling; at this presentation, the patient's serum creatinine level was 345 µmol/l (3.9 mg/dl), his urinalysis was trace positive for both protein and blood, the urinary sediment had no casts and his 24-hour urine collection showed 750 mg protein. The patient's renal function deteriorated over the next month, with his serum creatinine level reaching a peak of 530 µmol/l (6 mg/dl). He died 4 years and 3 months after transplantation as a result of an arrhythmia.

Investigations Physical examination, urine and blood analyses, ultrasound-guided renal biopsy and autopsy.

Diagnosis Polyomavirus-associated nephropathy with the development of end-stage renal disease.

Management Adjustment of immunosuppressive therapy and initiation of hemodialysis.

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Figure 1: Renal biopsy showing changes characteristic of polyomavirus infection

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Acknowledgements

The authors thank N Stanley Nahman Jr, MD for his critical appraisal of the article.

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Authors and Affiliations

  1. S Maddirala is Assistant Professor of Medicine at the University of Florida College of Medicine, Jacksonville, FL, USA.,

    Supriya Maddirala

  2. JV Pitha is Chief of the Veterans Affairs Medical Center Laboratory Service, Professor of Pathology and Adjunct Associate Professor of Dermatology, BD Cowley Jr is Professor and Chief of the Section of Nephrology and Hypertension, and L Haragsim is Associate Professor in the Section of Nephrology and Hypertension, at the University of Oklahoma College of Medicine, Oklahoma City, OK, USA.,

    Jan V Pitha, Benjamin D Cowley Jr & Lukas Haragsim

Authors
  1. Supriya Maddirala
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  2. Jan V Pitha
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  3. Benjamin D Cowley Jr
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  4. Lukas Haragsim
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Corresponding author

Correspondence to Supriya Maddirala.

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The authors declare no competing financial interests.

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Maddirala, S., Pitha, J., Cowley, B. et al. End-stage renal disease due to polyomavirus in a cardiac transplant patient. Nat Rev Nephrol 3, 393–396 (2007). https://doi.org/10.1038/ncpneph0512

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