CMV‐associated collapsing focal segmental glomerulosclerosis after kidney transplant in a pediatric patient

• Published in: Pediatric transplantation Vol. 27; no. 5; pp. e14535 - n/a
• Main Authors: Parr, Madeline F. E., Hidalgo, Guillermo, Goldstein, Michael J., Batal, Ibrahim, Lieberman, Kenneth V., Amoruso, Marlene R., Baer, Aryeh Z., Jain, Namrata G.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01-08-2023
• Subjects: Adult; Antiviral agents; Apolipoprotein L1; Biopsy; Child; collapsing focal segmental glomerulosclerosis; Creatinine; Cytomegalovirus; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - diagnosis; Glomerulosclerosis, Focal Segmental - complications; Glomerulosclerosis, Focal Segmental - diagnosis; Humans; Immunocompromised hosts; Immunosuppression; Kidney Failure, Chronic - complications; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Lupus nephritis; Male; Morbidity; Nephritis; Pediatrics; Proteinuria; Viremia; collapsing focal segmental glomerulosclerosis; cytomegalovirus; kidney transplantation; pediatrics
• ISSN: 1397-3142; 1399-3046; 1399-3046
• DOI: 10.1111/petr.14535

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.