title: Late-onset cytomegalovirus-associated interstitial nephritis in a kidney transplant.
abstract: Cytomegalovirus is the most important viral infection in kidney transplants, but rarely affects the allograft after the sixth month posttransplantation. We present a patient who developed renal failure eighteen months posttransplant; a kidney biopsy showed cytomegalovirus inclusions, acute tubular necrosis and mild interstitial nephritis. After intravenous ganciclovir, renal function transiently improved. Cytomegalovirus pp65 antigen was weekly reported as negative. One month later another biopsy was performed due to renal failure. The findings were consistent with tubular atrophy and severe interstitial nephritis. No cytomegalovirus cellular inclusions were found on histology, including immunohistochemical and polymerase chain reaction studies; pp65 antigen studies were persistently negative. Despite an attempt to recover renal function with steroid therapy, the patient restarted hemodialysis 20 months posttransplantation. This report suggests that cytomegalovirus should be considered as a late cause of kidney failure even in the absence of infection-related symptoms. The irreversible allograft damage can be caused despite the successful eradication of the virus with intravenous ganciclovir.
authors.affiliation: Department of Nephrology, Hospital Británico de Buenos Aires, Perdriel 74 (1280), Buenos Aires, Argentina. htrimarchi@hotmail.com
authors.forename: Hernán
authors.initials: H
authors.lastname: Trimarchi
authors.forename: R
authors.initials: R
authors.lastname: Jordan
authors.forename: A
authors.initials: A
authors.lastname: Iotti
authors.forename: M
authors.initials: M
authors.lastname: Forrester
authors.forename: R
authors.initials: R
authors.lastname: Iotti
authors.forename: E
authors.initials: E
authors.lastname: Freixas
authors.forename: J
authors.initials: J
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: Schropp
authors.forename: H
authors.initials: H
authors.lastname: Pereyra
authors.forename: E
authors.initials: E
authors.lastname: Efrón
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000473:pathology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir