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Clinical manifestations and diagnosis of BK virus-induced (polyomavirus-induced) nephropathy in kidney transplantation

Ajit P Limaye, MD, FACP, FIDSA
Daniel C Brennan, MD, FACP
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editors
Albert Q Lam, MD
Sheila Bond, MD


Polyomaviruses are small DNA viruses that infect a variety of animals, including monkeys, humans, rabbits, rodents, and birds, but tend to be species specific [1].

The human polyomaviruses, such as the BK and JC virus, are highly seroprevalent in humans but appear to cause clinical disease only in immunocompromised patients. BK virus is the primary cause of tubulointerstitial nephritis (BK virus nephropathy [BKVN]) and ureteral stenosis in renal transplant recipients and hemorrhagic cystitis in bone marrow transplant recipients.

JC virus may also cause a small proportion (<5 percent) of polyomavirus nephropathy among renal transplant recipients, though perhaps with more inflammation and focal fibrosis, and is typically associated with a milder clinical course [2-6]. In this topic review, polyoma virus-induced nephropathy refers to BKVN.

The clinical manifestations and diagnosis of BKVN in kidney transplant recipients will be presented here. BK-associated ureteral stenosis is discussed elsewhere (see "Ureteral stenosis due to BK virus infection among kidney transplant recipients"). The treatment and general overviews of BK and other polyoma viruses are also discussed separately. (See "Overview of JC polyomavirus, BK polyomavirus, and other polyomavirus infections" and "Virology, epidemiology, and pathogenesis of JC polyomavirus, BK polyomavirus, and other human polyomaviruses".)


The polyomaviruses are small (30 to 45 nm), icosahedral, nonenveloped, double-stranded, circular DNA viruses that are ubiquitous to humans, occurring with a seroprevalence of 60 to 80 percent [7-13]. BK and JC viruses encode six viral proteins. These are divided into two "early" nonstructural or enzymatic proteins, an agnoprotein, and three "late" proteins. The early proteins are the large tumor antigen, or "T antigen," and the small tumor antigen, or the "t antigen." The T antigen is responsible for cell immortalization and latency. The agnogene, which transcribes the agnoprotein, appears to participate in the assembly of viral particles. The "late" genes encode three viral capsid proteins: VP-1, VP-2, and VP-3.

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Literature review current through: Nov 2017. | This topic last updated: Apr 27, 2016.
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