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🫘 Clinical Case Challenge
📚 Source: BoardVitals — Nephrology

📝 A 38 year old man with ESRD due to diabetes received a deceased donor kidney transplant one year ago. His immediate post-transplant course was complicated with acute rejection, which was treated with high dose steroid and anti-thymocyte globulin. Later he developed BK viremia and his mycophenolic acid was discontinued. Currently he is maintained on tacrolimus and prednisone only. His serum BK PCR is getting better, with last serum BK PCR of 12,000 copies/ml from 18,000 copies/ml. You obtained a kidney biopsy for rising creatinine, which is as below. What should be the best next step?

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