End-stage renal disease due to polyomavirus in a cardiac transplant patient

Background: A 51-year-old male orthotopic cardiac transplant recipient experienced a prolonged rejection episode immediately after transplantation. Three years and 5 months after transplantation, he presented with lower extremity swelling; at this presentation, the patient's serum creatinine level was 345 μmol/l (3.9 mg/dl), his urinalysis was trace positive for both protein and blood, the urinary sediment had no casts and his 24-hour urine collection showed 750 mg protein. The patient's renal function deteriorated over the next month, with his serum creatinine level reaching a peak of 530 μmol/l (6 mg/dl). He died 4 years and 3 months after transplantation as a result of an arrhythmia. Investigations: Physical examination, urine and blood analyses, ultrasound-guided renal biopsy and autopsy. Diagnosis: Polyomavirus-associated nephropathy with the development of end-stage renal disease. Management: Adjustment of immunosuppressive therapy and initiation of hemodialysis.