Hydronephrosis Resulting from Bilateral Ureteral Stenosis: A Late Complication of Polyoma BK Virus Cystitis?

N Basara,M Maier,J Ivovic,T Schwalenberg,F.-M Rasche,C Wickenhauser,D Niederwieser,T H Lindner

doi:10.1155/2010/297358

Abstract

We report here a case of acute lymphoblastic leukemia in remission presenting a late-onset bilateral hydronephrosis probably due to polyoma BK virus-induced proliferation of bladder endothelium on both ostii. The diagnosis was made virologically by BK virus Polymerase Chain Reaction (PCR) detection in the absence of any other bladder disease. Awareness of this late complication is necessary not only in patients after renal transplantation but also in patients after hematopoietic stem cell transplantation from matched unrelated donor.

Highlights

Polyomavirus BK was first isolated 1971 from the urine of an asymptomatic renal transplant patient who was hospitalized with acute renal injury and with initials BK [1]
We described a young patient with precursor T-ALL who had received an unrelated matched donor PBSCT and one year later presented with increase creatinine levels and bilateral hydronephrosis
This case demonstrated a very late proliferative endothelial infection by a virus related to severe viral load and hemorrhagic cystitis 4 weeks after unrelated PBSCT

Summary

Introduction

Polyomavirus BK was first isolated 1971 from the urine of an asymptomatic renal transplant patient who was hospitalized with acute renal injury and with initials BK [1]. It is a deoxyribonucleic acid (DNA) virus with circular doublestranded DNA genome and a nonenveloped icosahedral capsid [2]. More than 80 percent of adults had serologic evidence of infection [3] In immunocompromised hosts, such as renal transplant patients, BK virus may reactivate and cause hemorrhagic cystitis and severe allograft dysfunction with acute tubulointerstitial nephritis [4, 5]. About 50% of patients after hematopoietic bone marrow transplantation presented with BK viruria, usually within 2 months of transplantation [10, 11], with similar incidence in both autologous and allogenic recipients (39–54%) [12]

Case Report

Detection of BK Virus by Real Time PCR

Findings

Discussion