A case of severe nephrotic syndrome caused by isolated CMV glomerulopathy with ganciclovir resistant UL 97 mutation

Abstract

Introduction: While many cases of cytomegalovirus (CMV) nephropathy have been reported in the literature, isolated CMV glomerulopathy is considered a rare finding. Case Presentation: We report the case of a CMV-negative recipient of kidney allograft from a CMVpositive donor (D+/R-), the recipient subsequently developed severe nephrotic syndrome secondary to biopsy-proven isolated CMV glomerulopathy. Conclusion: The patient developed CMV viremia with ganciclovir resistant UL97 mutation. His treatment course was resistant to recommended dose of intravenous ganciclovir, so therapy was changed to foscarnet with resolution of his viremia and reduction in proteinuria.

Cytomegalovirus glomerulopathy in renal allografts

“…unna et al in a recent issue of this journal described a case of severe nephrotic syndrome caused by isolated renal allograft cytomegalovirus (CMV) glomerulopathy in a 63-year old African American man with end-stage renal disease secondary to hypertension after he received a deceased CMV D+/R-renal allograft (1). Induction therapy was with thymoglobulin, and he was on triple maintenance immunosuppression with mycophenolic acid (Myfortic), prednisone and tacrolimus (1). Several glomeruli showed viral cytopathic effect consistent with CMV infection and immunohistochemical staining for CMV showed occasional glomerular cells with positive label and was negative in tubules and in the interstitium (1).…”

“…Induction therapy was with thymoglobulin, and he was on triple maintenance immunosuppression with mycophenolic acid (Myfortic), prednisone and tacrolimus (1). Several glomeruli showed viral cytopathic effect consistent with CMV infection and immunohistochemical staining for CMV showed occasional glomerular cells with positive label and was negative in tubules and in the interstitium (1).…”