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Kidney Week

Abstract: PO1485

Minimal Change Disease as a Novel Manifestation of Cytomegalovirus

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Lee, Andrew, East Carolina University Division of Health Sciences, Greenville, North Carolina, United States
  • Lai, Hsiao Ling, East Carolina University Division of Health Sciences, Greenville, North Carolina, United States
  • Thayyil, Abdullah, East Carolina University Division of Health Sciences, Greenville, North Carolina, United States
  • Obi, Reginald Ifeanyi, East Carolina University Division of Health Sciences, Greenville, North Carolina, United States

Group or Team Name

  • ECU Nephrology and Hypertension
Introduction

Cytomegalovirus (CMV) infection is typically asymptomatic among the immunocompetent or can cause a mononucleosis. Among immunosuppressed patients common presentations are colitis, hepatitis, encephalitis, retinitis and even Guillian-Barre syndrome. This case is a rare disseminated presentation of CMV manifesting as acute glomerulopathy.

Case Description

A 67 year-old female with past medical history of lupus, rheumatoid arthritis, and Sjogrens syndrome on maintenance steroids presented with a prolonged cough, joint swelling, shortness of breath and rash consistent with livedo reticularis. She developed worsening weakness in the arms and legs. High dose IV steroids were initiated for presumed rheumatoid vasculitis. Nephrology was consulted for worsening renal function with urine protein to creatinine ratio of 42 g, later requiring hemodialysis for volume management. Work up for nephrotic range proteinuria including hepatitis B/C, HIV, SPEP, UPEP, and complement screen was unrevealing. Renal ultrasound demonstrated an 11.7 cm right kidney and 14 cm left kidney. Renal biopsy demonstrated diffuse podocyte effacement and large atypical mononuclear cells within the glomerulus. No immune deposits seen on electron microscopy. Immunohistochemical staining confirmed glomerular CMV. Six weeks after starting treatment with ganciclovir and tapering steroids, CMV viral load was undetectable and renal function recovered to baseline.

Discussion

CMV involvement of the kidney is unusual aside from tubulointerstitial nephritis. Rare cases of collapsing glomerulopathy and focal segmental glomerular sclerosis are found in literature. We report a novel presentation of CMV glomerulopathy with minimal change disease and renal failure. To prevent tissue invasive CMV in a chronically immune suppressed patient one needs to maintain clinical suspicion for infectious pathogens and perform tissue biopsy.

PAS of glomerulus showing giant cell