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The virus reactivates in immunodeficiency states, mostly among transplant (either kidney or bone marrow) recipients. There are approximately 15\u2009000 renal transplants every year in the USA, of which 5\u201310% develop BK polyomavirus nephropathy; 50\u201380% of patients who develop nephropathy go on to develop graft failure. BK virus is associated with BK polyomavirus nephropathy, ureteral stenosis, late-onset hemorrhagic cystitis, bladder cancer and other nonlytic large T-expressing carcinomas. The renal spectrum begins with viruria and can end with graft failure. The clinical spectrum and outcomes vary among transplant patients. New noninvasive diagnostic methods, such as urinary polyomavirus Haufen detected by electron microscopy, are currently under study. Treatment is primarily directed at decreasing immunosuppression but may be associated with graft rejection. Repeat transplantation is encouraged as long as viral clearance in plasma prior to transplant is accomplished. There remain no definitive data regarding the utility of transplant nephrectomy.<\/jats:p>","DOI":"10.1093\/ndt\/gfz273","type":"journal-article","created":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T20:11:01Z","timestamp":1574885461000},"page":"587-593","source":"Crossref","is-referenced-by-count":34,"title":["BK polyomavirus\u2014pathogen, paradigm and puzzle"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7701-4596","authenticated-orcid":false,"given":"Suman Krishna","family":"Kotla","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep V","family":"Kadambi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Florida, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen R","family":"Hendricks","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Rojas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,12,31]]},"reference":[{"key":"2021033008565881700_gfz273-B1","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1099\/vir.0.80363-0","article-title":"Subtypes of BK virus prevalent in Japan and variation in their transcriptional control region","volume":"85","author":"Takasaka","year":"2004","journal-title":"J Gen 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