BK nephropathy in pediatric renal transplantation

BKV associated nephropathy is an important and common complication after renal transplantation. BKV nephropathy is a significant risk factor of graft dysfunction and an important cause of graft loss. The risk factors of BKV associated nephropathy are younger age of recipients, HLA mismatching, the number of acute rejection episodes, the presence of delayed graft failure, increased cold ischemia time, induction by tymoglobuline and use of mycophenolate mofetil with tacrolimus in maintenance therapy. Over the past years, the studies focused on the preventive protocols. Ciprofloxacine has not any effect to prevent BKV use of brincidofovir, ‘lipid oral formulation of cidofovir’, is effective as prophylaxis. BKV vaccine is also under research. Treatment options are limited and controversial. The mainstay treatment is immunosuppressive reduction. Discontinuation of mycophenolate mofetil is a common approach. Conversion of tacrolimus to cyclosporine is another approach. There are other therapeutic options such as the use of leflonamide, cidofovir, IVIg and everolimus