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Kidney Week

Abstract: PO2450

Cytomegalovirus Nephropathy in a Renal Transplant Patient

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Gilligan, Sarah, University of Utah Hospital, Salt Lake City, Utah, United States
  • Raghavan, Divya, University of Utah Hospital, Salt Lake City, Utah, United States
  • Hall, Isaac E., University of Utah Hospital, Salt Lake City, Utah, United States
  • Shihab, Fuad S., University of Utah Hospital, Salt Lake City, Utah, United States
  • Barry, Marc, University of Utah Hospital, Salt Lake City, Utah, United States
  • Al-Rabadi, Laith, University of Utah Hospital, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Hospital, Salt Lake City, Utah, United States
Introduction

Human cytomegalovirus (CMV), a DNA virus in the human herpesviridae family, is a frequent opportunistic infection following renal transplant. It can present as viremia without end organ damage and can affect the GI tract, liver, and lungs. CMV nephropathy is an uncommon complication of systemic CMV infection, occurring in < 1% of infected patients. Here we present a case of a renal transplant patient with CMV viremia was found to have evidence of CMV infection in the kidney.

Case Description

The patient was a 57 year old woman who had undergone deceased donor renal transplant 5 months prior to presentation due to ANCA vasculitis. Pre-transplant serologies were CMV D+/R- and induction was alemtuzumab. Her immune suppressive regime was tacrolimus, mycophenolic acid, and prednisone. She presented to the hospital with progressive fatigue, shortness of breath with new 4 L oxygen requirement, and decreased oral intake for several weeks. Her post-transplant creatinine nadir was 1.2 mg/dl, up to 3.1 mg/dl on admission and uptrended to 5.1 mg/dl, briefly requiring CRRT. She was found to have multiple infections including CMV viremia (peak > 3.9 M copy/mL) and pneumonitis, pseudomonas pneumonia, JC in her CSF and serum, and eventually bacteroides bacteremia due to bowel perforation. She underwent kidney biopsy which showed acute tubular necrosis, scattered glomerular epithelial cells and rare peritubular capillary endothelial cells positive for CMV by immunostaining (negative for BK/JC and rejection). She was treated with ganciclovir with resolution of her CMV viremia and improvement in her renal function, however, unfortunately passed due to her multiple infections.

Discussion


There are several possible manifestations of CMV nephropathy including interstitial nephritis, positive staining for CMV inclusions in glomerular cells, and collapsing focal segmental glomerulosclerosis. CMV nephropathy is an uncommon complication of CMV viremia following renal transplant but should be considered in the differential diagnosis of patients with CMV viremia and AKI.