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Ureteral stenosis due to BK virus infection among kidney transplant recipients

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 ubiquitous, small DNA viruses that infect a variety of animals including monkeys, humans, rabbits, rodents, and birds, but they tend to be species specific. Although the human polyomaviruses are highly seroprevalent in humans, they appear to cause clinical disease only among immunocompromised patients. BK virus and JC virus are the two classical human polyoma viruses.

In kidney transplant recipients, the major diseases associated with BK virus are tubulointerstitial nephritis and ureteral stenosis. BK virus may cause clinical disease of the genitourinary tract due in part to its tropism for renourinary epithelium.

The first association of BK with ureteral stenosis was in the seminal 1971 publication reporting isolation of a new virus, BK, named for the initials of the first patient who presented three months after transplant with obstructive uropathy [1]. It remains uncertain whether BK virus is the primary cause of ureteric stenosis or whether BK virus infects previously injured ureter (from ischemia or other trauma) as a secondary insult.

Ureteral stenosis associated with BK virus infection among kidney transplant recipients is discussed in this topic review. BK-induced nephritis in kidney transplant recipients is discussed separately. (See "Prevention and management of BK virus-induced (polyomavirus-induced) nephropathy in kidney transplantation" and "Clinical manifestations and diagnosis of BK virus-induced (polyomavirus-induced) nephropathy in kidney transplantation".)


The incidence of ureteral stenosis due to BK virus infection among renal allograft recipients is approximately 3 percent [2,3]. In the renal transplant setting, ureteral stenosis (which occurs from 0.5 to 6 percent in the general transplant population [4]) has traditionally been attributed to either surgical technique or watershed infarction of the distal ureter and not to BK viral involvement.

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Literature review current through: Nov 2017. | This topic last updated: Apr 18, 2016.
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