Abstract: TH-PO0913
Cytomegalovirus Nephritis Presenting with Collapsing Glomerulopathy and Proteinuria in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Kumar, Shaurya, Fortis Escorts Heart Institute and Research Centre, New Delhi, DL, India
- Watchmaker, Maxwell C, Washington University in St Louis, St. Louis, Missouri, United States
- Lewis, Ian Z., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Vasudev, Brahm S., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction
Cytomegalovirus (CMV) infection is a well-known risk for allograft dysfunction and graft failure in renal transplant recipients. Though rare, CMV nephritis remains underdiagnosed without confirmatory biopsy, and may mimic other common causes of kidney injury in this population. We present an atypical case of CMV nephritis with proteinuria and collapsing glomerulopathy.
Case Description
A 78-year-old male with ESRD due to hypertension underwent a deceased donor kidney transplant, which was CMV D+/R-. Past medical history included diabetes, atrial fibrillation, DVT and prostate cancer post TURP. He received induction therapy with Thymoglobulin and IV Methylprednisolone, followed by maintenance Tacrolimus, Mycophenolate and Prednisone. He completed a 6-month course of Valganciclovir prophylaxis due to high risk serostatus.
Months later, the patient arrived with loose stools and serum creatinine of 6.3 mg/dL, which failed to improve with fluids. The workup revealed proteinuria (UPCR2400mg/g), and elevated CMV NAAT (85,000 copies/mL). Further testing was negative for hepatitis, BK virus, hypocomplementemia, and monoclonal gammopathy.
Transplanted kidney biopsy displayed collapsing glomerulopathy with positive immunostaining in glomerular endothelial cells. The patient was treated with Valganciclovir for 10 weeks, low dose Lisinopril and reduced immunosuppression regimen. On follow up, the serum creatinine improved to 1.4-1.6mg/dL, with decreased proteinuria and undetectable CMV PCR.
Discussion
CMV nephritis should be considered in high risk serostatus patients post renal transplant presenting with graft dysfunction, even after prophylaxis has been discontinued. This case illustrates the atypical presentation with proteinuria and collapsing glomerulopathy, highlighting the need for renal biopsy and early antiviral therapy for allograft salvage.
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC8852648/
https://www.ajkd.org/article/S0272-6386(11)00733-5/fulltext
https://pmc.ncbi.nlm.nih.gov/articles/PMC5754335/#:~:text=CMV%20infection%20is%20common%20after,)%20%5B5–8%5D.