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Kidney Week

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Abstract: PUB645

Transplant Renal Artery Stenosis in a Child with BK Nephropathy

Session Information

Category: Trainee Case Report

  • 1700 Pediatric Nephrology

Authors

  • Mannemuddhu, Sai Sudha, University of Florida. College of Medicine., Gainesville, Florida, United States
  • Tufan pekkucuksen, Naile, University of FLorida, Gainesville, Florida, United States
  • Upadhyay, Kiran K., University of Florida. College of Medicine., Gainesville, Florida, United States
Introduction

Transplant renal artery stenosis (TRAS) and BK nephropathy are known complications of renal transplantation, but the association has not been reported.

Case Description

A 2-year-old girl received a kidney transplant from a 20-year-old deceased donor, along with native nephrectomies. She had a delayed graft function due to a renal artery thrombus and required thrombectomy with reanastomosis, heparin and aspirin. Thymoglobulin, tacrolimus and mycophenolate were started. CMV and EBV DNA PCRs were negative but developed BK viremia at 2 months (peak 260,000 copies/mL). Serum creatinine remained stable at a baseline of 0.9 mg/dL. After immunosuppression reduction and leflunomide initiation, her BK load decreased to 1200 copies/mL after 4 months. There were no episodes of rejections, hydronephrosis or hematuria. Blood pressure (BP) was well controlled on low dose amlodipine. 5 months later, she presented with hypertensive emergency, following a respiratory infection. Her BPs remained refractory to 8 antihypertensive agents and required dialysis for oliguric acute kidney injury. Allograft biopsy showed evidence of BK nephropathy. Immunosuppression was further minimized. Doppler renal sonogram and duplex study of renal artery were both suggestive of TRAS. Angiogram showed severe proximal anastomotic TRAS (> 95% occlusion). Balloon angioplasty with stenting was done with immediate improvement in the blood flow and gradient reduction to 18 from 50 mm Hg. BPs and renal function normalized. 7 months post-transplant, she remains stable, with no BK viremia and while on 2 antihypertensives.

Discussion

Although ureteral and urethral stenosis are known to occur with BK infection, TRAS is an interesting association. Timely recognition and management of both is important to prevent uncontrolled hypertension and allograft dysfunction.