BK Virus: A Recap

Good news! I found the missing email. It had been filed under Important. Who knew there was such a folder. The reader asked how high my numbers had been, so I've been tracking them down through my blog pages. Here's what I found along with creatinine levels:


The BK was discovered after elevation of creatinine to 2.6 was noted during a normal visit to the clinic. A kidney biopsy was performed to determine whether the cause was rejection or BK Virus. BK was confirmed with 497,000 copies of the virus found in the serum test.


Dr. M reduced dosage of both Prograf and Myfortic and prescribed a round of Ciproflaxcin. After two weeks serum test copies were reduced to 73,000. Creatinine was slightly elevated, blood pressure was becoming more difficult to control.


Two weeks after the Ciproflaxcin, the serum test revealed an increase to 156,000 copies. Moreover, Creatinine was continuing to rise (3.1) indicating the inflammation was doing damage to the kidney.


Dr. M reduced the Prograf again and discontinued the Myfortic. Two weeks later, the serum test revealed reduction to 45,000 copies, but two weeks after that it was back up to 54,000. Creatinine continued to slowly elevate.


Then he began a series of treatments with Cidofovir, an antiviral that had been developed to fight aids. Its primary use was to treat retinal inflammations in HIV patients. Its primary side effect is its toxicity to kidneys. He also administered an infusion of IVIG (intravenous immuno-globulin) which produced fever and convulsions (I reacted horribly to the drug.)  


Serum tests revealed a reduction in copies, first to 3150, then to 650. However creatine was up to 5.6. We don't know whether it was the toxicity of the cidofovir or the reaction to the IVIG that caused the damage, or the continued damage from the BK Virus. Dr M then prescribed treatment with leflunamide,  an antiviral whose primary use is to treat rheumatoid arthritis. It caused a retinal inflammation and was discontinued.


The next two serum tests, however, revealed 0 copies of the virus. A test twelve months later revealed the same result. So I hopefully remain free of the virus. Creatine came down to 3.1 and has been steady for the last year. I have had no further issues with high blood pressure.


The reader asks about a safe level of BK Virus. I don't know if there is one. My doctors chose to keep fighting even when the level was low. If the virus is active I think it's doing damage. Anyway, good luck. Your doctors should be willing to discuss all options with you. The response to BK was not set in protocol when I was undergoing treatment.

Beginning Year 3 Post Transplant

It was between verses of the last hymn Sunday as we (the choir) stood alongside the congregation that I realized that I had just passed the second anniversary of my transplant. It was strange that I hadn't been aware of the date as the first anniversary had been such a huge emotional event for me. It's not that I just forget about it, but rather that being a transplant recipient has become an integral part of the natural fabric of my life.

So rather than look back a second anniversary, I will look ahead to beginning year 3.

Besides, the big date this year was turning 60 a few weeks ago. Ouch, that hurt. 60 might be the new 50 and that's middle age, but 70 is next and that just damned old!

BK Virus is still the medical news. The number of copies in the serum tests have been as high as 3150 and the last number was 650, a new low. Had a Cidofovir infusion today and will repeat in two weeks before I see the doctor again and get results. They also doubled my leflunomide prescription to see if we can get this thing eradicated. 

Yikes, the nurse today was so stiff. Today was the third infusion he's administered and the second in two weeks. Yet he never smiled or showed any sign of recognition. Jeez! I work retail and remember customers and I see way more customers than he sees patients! Other nurses greet me by name so it doesn't seem so unreasonable...

Anniversary also means it's time for a Glofil test.  Glofil gives a detailed look at the Glomular Filtration Rate which is the ultimate measure of kidney function. Hydration is the name of the Glofil game. Preparation involves drinking water until it's leaking out your ears and then ingesting an Iodine stain and receiving an injection of radioactive sodium iothalamate. Then as you drink more water over the next three hours, blood draws and urine collections measure how well the kidney filters the solution out of the blood. Dallas Transplant administers the test several times during the first year post transplant, then it's done on an annual basis after that. I'll get the results when I go back to the clinic in a couple of weeks.