Clinical Presentation & Protocol
Patient Usually Complains Of
Patient is a renal transplant recipient presenting with a rising serum creatinine and/or persistent BK viremia. Current immunosuppression regimen reviewed. No symptoms of graft tenderness or systemic viral syndrome. Recent labs demonstrate [insert BK PCR viral load] copies/mL. Urine cytology positive for decoy cells.
Clinical Examination Findings
Patient is hemodynamically stable, afebrile. Renal allograft palpated in the [right/left] iliac fossa; no focal tenderness, no palpable mass, no overlying erythema. No peripheral edema noted. Surgical incision site well-healed without signs of infection.
Treatment Protocol
Plan: 1. Reduction of immunosuppression (calcineurin inhibitor dose reduction/withdrawal of antimetabolite). 2. Initiation of adjuvant therapy (e.g., IVIG, Leflunomide, or Cidofovir) as indicated by viral load kinetics. 3. Serial monitoring of BK PCR and serum creatinine weekly. 4. Maintain adequate hydration.