BKVN leads to allograft dysfunction following kidney transplantation and is preceded by BK viremia. Studies in pediatric kidney transplant recipients reveal an incidence of viruria ranging from 18% to 33%, viremia 6-16%, and BKVN 2-8%. Specific risk factors have not been clearly elucidated. Retrospective chart review of pediatric kidney transplants performed from January 2005 through December 2009; to identify risk factors associated with BK viremia in pediatric kidney transplant recipients from a single center. Of the 93 patients who received kidney transplants in the study period, 22 (24%) developed BK viruria, including 12 (13%) who developed viremia. One patient with viremia (1.6%) had BKVN. Obstructive uropathy was identified as the cause of ESKD in 22 (24%) of all recipients. 27% (n = 6) of these 22 patients developed viremia, while only 8.5% (6/71) with ESKD from another cause had viremia (p = 0.001). No other examined variable differed between the two groups. Although the overall incidence was no higher than other reported series, we identified that BK disease was more frequent in children with OU. A higher index of suspicion for invasive BK disease is necessary in patients with OU who receive kidney allografts. Transplant protocols may need to consider underlying cause of ESKD when designing screening protocols for BK disease in children after kidney transplantation.