Irreversible glomerular lesions induced by crystal precipitation in a renal transplant after foscarnet therapy for cytomegalovirus infection.
OBJECTIVE
Foscarnet is an antiviral agent used to treat cytomegalovirus infection in AIDS patients and in transplant recipients. In most cases, foscarnet induces reversible tubulo-interstitial lesions which can be avoided by correct hydration. We report the first case of crystal foscarnet precipitation within glomerular capillaries in a renal transplant.


RESULTS
The recipient, a 49-year-old man, developed a nephrotic syndrome with haematuria and an acute renal failure after foscarnet therapy for cytomegalovirus (CMV) infection. The polarization examination of the first graft biopsy revealed the presence of birefringent crystals within glomeruli and tubules. Infrared analysis attested to the presence of trisodium foscarnet salts and mixed sodium calcium salts coloured by Von Kossa's reaction. A second biopsy showed glomerular sclerosis, interstitial fibrosis, tubular atrophy and crystal vanishing. Polymerase chain reaction (PCR) in situ applied to this biopsy confirmed the diagnosis of cytomegalovirus infection.


CONCLUSIONS
These adverse effects might be the result of a toxic synergy between foscarnet and other drugs. In cases with crystalline precipitation, graft biopsy remains the best mean of diagnosis and follow-up of glomerular damage.
Justrabo
E
E
Department of Pathology, Dijon University Hospital, France.
Zanetta
G
G
Martin
L
L
Assem
M
M
Mousson
C
C
Maurice-Estepa
L
L
Rifle
G
G
Tanter
Y
Y
D001706:Biopsy; D001718:Birefringence; D003460:Crystallization; D003586:Cytomegalovirus Infections / Q000188:drug therapy; D017245:Foscarnet / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000473:pathology; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged
D017245:Foscarnet