title: Cytomegalovirus-induced necrotizing and crescentic glomerulonephritis in a renal transplant patient.
abstract: A 35-year-old black man with end-stage renal disease from biopsy-proven focal segmental glomerulosclerosis developed worsening function of his renal allograft 160 days after living related donor renal transplantation. Renal biopsy showed necrotizing and crescentic glomerulonephritis (NCGN) and presence of intraglomerular viral inclusions confirmed by immunocytochemical stain and in situ hybridization techniques to be cytomegaloviral in origin. Electron microscopy showed no immune complexes, and workup for other causes of NCGN was negative. The patient was treated with ganciclovir without other changes in his immunosuppressive regimen. After 8 weeks of ganciclovir therapy, a second renal transplant biopsy showed resolution of the glomerular process and disappearance of the cytomegalovirus (CMV) inclusions. The resolution of the glomerular process with treatment for CMV infection, and without other change in therapy, strongly supports a causative link between CMV and NCGN in this patient. This case represents the first report of CMV-associated NCGN in a renal transplant patient.
authors.affiliation: Department of Pathology, East Carolina University School of Medicine, Greenville, NC 27858, USA. rdetwiler@ccusom.som
authors.forename: R K
authors.initials: RK
authors.lastname: Detwiler
authors.forename: H K
authors.initials: HK
authors.lastname: Singh
authors.forename: P
authors.initials: P
authors.lastname: Bolin
authors.forename: J C
authors.initials: JC
authors.lastname: Jennette
mesh_terms: D000328:Adult; D000936:Antigen-Antibody Complex / Q000648:ultrastructure; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D003587:Cytomegalovirus / Q000648:ultrastructure; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy; D015774:Ganciclovir / Q000627:therapeutic use; D005921:Glomerulonephritis / Q000188:drug therapy / Q000821:virology*; D005923:Glomerulosclerosis, Focal Segmental / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007181:Inclusion Bodies, Viral / Q000648:ultrastructure; D007678:Kidney Glomerulus / Q000821:virology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008854:Microscopy, Electron; D009336:Necrosis; D014184:Transplantation, Homologous
chemical_list: D000936:Antigen-Antibody Complex; D000998:Antiviral Agents; D015774:Ganciclovir