Cytomegalovirus is the most common viral infection in organ transplant recipients. CMV disease commonly manifests as meningoencephalitis, pneumonitis, hepatitis, and colitis. Kidney involvement of CMV is otherwise rare. We present five cases of CMV renal infection (Table 1).

Cases

1: 32/M had deceased donor kidney transplant (DDKT) that failed due to rejection. Pt had repeat DDKT. Baseline CrCl is 67 ml/min, but acutely decreased to 37 ml/min 13 mos post-transplant. Pt had C. difficile infection treated with oral Vancomycin. Scr continued to increase despite resolution of diarrhea. Kidney biopsy revealed CMV-associated collapsing glomerulopathy.

2: 18/M had DDKT with baseline CrCl 92 ml/min. 4 mos post-transplant, pt had CMV colitis, treated with Ganciclovir (GCV). Despite aggressive rehydration, CrCl continued to decrease to 39 ml/min. Kidney biopsy showed CMV viral inclusions in glomerular endothelial cells.

3: 29/M had DDKT that failed after 10 yrs. He had repeat DDKT complicated by protracted course of delayed graft function requiring dialysis. Pt had CMV viremia associated with fever and leukopenia 3 mos post-transplant. Kidney biopsy showed CMV in glomeruli.

4: 58/M had DDKT with baseline CrCl 44 ml/min. Pt had CMV colitis 3 mos post-transplant, treated with GCV. Despite rehydration and improvement of diarrhea, CrCl continued to decline to 23 ml/min. Kidney biopsy showed thrombotic microangiopathy and CMV viral inclusions in glomerular endothelial cells.

5: 54/M had DDKT with baseline CrCl 50 ml/min. 20 mos post-transplant, CrCl declined to 35 ml/min. Pt also had 1g proteinuria. Kidney biopsy revealed intranuclear and intracytoplasmic CMV viral inclusions in enlarged tubular cells. CMV blood PCR was undetectable.Discussion: Without prophylaxis, CMV disease occurs in 45% of D+/R- kidney transplant recipients. CMV infection has been associated with reduced renal allograft function and survival. However, invasive CMV disease involving the renal allograft is uncommon. The spectrum of renal allograft pathology due to CMV can demonstrate tubulointerstitial or glomerular changes. Renal outcomes following antiviral treatment vary depending on severity of pathology.

CITATION INFORMATION: Posadas Salas M, Thompson J, Ngo T, Self S. Cytomegalovirus Renal Infection: Rare Manifestation of a Common Post-Transplant Viral Infection — A Case Series. Am J Transplant. 2017;17 (suppl 3).

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