There is no active treatment for post-renal transplantation BK virus nephropathy (BKVN) proved to be effective so far. Leflunomide, intravenous immunoglobulin (IVIG) and ciprofloxacin are still under investigation as active measures for BKVN treatment. The aim of this study is to assess the efficacy of active management for BKVN on graft outcome after one year. Renal transplant recipients (RTR) with positive BKV-PCR in urine and blood twice underwent graft biopsy to confirm BKVN. Once BKVN is diagnosed, anti-metabolites (mycophenolate mofetil or azathioprine) were changed to leflunomide and a course of IVIG and oral ciprofloxacin were given followed by serial monitoring of creatinine clearance (CCl), BKV-PCR in urine and blood. Eighteen RTR were reviewed, 72% were males, one RTR received the second renal transplant, deceased donors were 50%, mean HLA mismatches was 3.6, all RTR received induction therapy (61% thymoglobulin and 39% basiliximab) and 61% received antirejection treatment before diagnosing BKVN. Maintenance immuno­suppression was prednisolone (93%), MMF as 2gm daily (93%), Tacrolimus (61%), CsA(33.5%) and sirolimus (5.5%). Baseline mean CCl was 35.6 ± 11.5 which was reduced to 29.3 ± 17.3 ml/min/1.73 m2 at one year (p 0.012). According to baseline CCl value above and below 40 ml/min/1.73 m2, patients were divided into two groups; 9 RTR in each with mean CCl 44.5 and 25.3 ml/min/1.73m2 for group 1 and 2 respectively. At one year, mean CCl was reduced to 42.6 ml/min/1.73 m2 (p 0.279) for group1 and 16.7 ml/min/1.73 m2 (p 0.016) for group2. Three grafts were lost by the end of the study (16.7%), all were in group 2 (p 0.031). In conclusion, lack of regular screening, late diagnosis and heavy immunosuppression are predisposing factors for development of BKVN. Active treatment for BKVN by leflunomide, IVIG and ciprofloxacin may improve graft outcome at one year if given early before significant deterioration of graft function occurs.