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Published on: May 7, 2012
CMV-associated collapsing focal segmental glomerulosclerosis after kidney transplant in a pediatric patient
Madeline F E Parr1, Guillermo Hidalgo2, Michael J Goldstein3
1Division of Pediatric Nephrology, Department of Pediatrics, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.
Background:
Cytomegalovirus (CMV) is a significant cause of morbidity among immunocompromised patients who have undergone kidney transplantation and is known to rarely induce collapsing focal segmental glomerulosclerosis (FSGS) among adults.
Methods:
We present the first reported case of CMV-induced collapsing FSGS in a pediatric patient after kidney transplant.
Results:
Our patient underwent a deceased donor kidney transplant due to end-stage renal disease secondary to lupus nephritis. Approximately 4 months after transplantation, he developed signs of worsening kidney function in the setting of CMV viremia and was found to have collapsing features of FSGS on kidney transplant biopsy. He was managed with a prompt escalation of antiviral therapy along with a reduction of immunosuppression and recovered without significant complication. At follow-up, he continued to have undetectable CMV titers, creatinine within normal limits, and no significant proteinuria.
Conclusion:
This report demonstrates CMV as a cause of collapsing FSGS and should be considered among pediatric transplant recipients who present with acute kidney injury, as should early assessment of APOL1 genetic status in both donor and recipient.
Insights
Cytomegalovirus (CMV) infection can cause collapsing focal segmental glomerulosclerosis (FSGS) in pediatric kidney transplant recipients. Prompt antiviral therapy and reduced immunosuppression led to recovery, highlighting CMV as a potential cause of kidney injury.
Area of Science:
- Nephrology
- Virology
- Pediatric Transplantation
Background:
- Cytomegalovirus (CMV) is a known complication in immunocompromised patients, particularly kidney transplant recipients.
- CMV rarely causes collapsing focal segmental glomerulosclerosis (FSGS) in adults.
Observation:
- This case report details the first instance of CMV-induced collapsing FSGS in a pediatric kidney transplant recipient.
- The patient presented with worsening kidney function and CMV viremia four months post-transplant.
- Kidney biopsy confirmed collapsing FSGS features.
Findings:
- The pediatric patient received a deceased donor kidney transplant for end-stage renal disease due to lupus nephritis.
- Management involved escalated antiviral therapy and reduced immunosuppression.
- The patient showed significant recovery with normal creatinine and minimal proteinuria post-treatment.
Implications:
- Cytomegalovirus should be considered a potential cause of collapsing FSGS in pediatric transplant recipients presenting with acute kidney injury.
- Early assessment of APOL1 genetic status in both donors and recipients is recommended.
- This case expands the understanding of CMV-related kidney complications in pediatric transplantation.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:24Chronic Kidney Disease II: Clinical Manifestations