Glomerulopathy Associated with Cytomegalovirus Viremia in Renal Allografts

Abstract

We investigated the relation between cytomegalovirus (CMV) infection and renal-allograft dysfunction in 14 patients. In seven instances (including two successive transplants in one patient), allograft dysfunction occurred during clinically manifest, viremic CMV infection. In five of these, biopsies revealed little or no tubulointerstitial change but a distinctive, diffuse glomerulopathy characterized by enlargement or necrosis of endothelial cells and accumulation of mononuclear cells and fibrillar material in glomerular capillaries. Two of these allografts recovered their function, both with cessation of high-dose immunosuppression. Biopsies in the other 10 patients revealed predominantly tubulointerstitial changes typical of cellular rejection, and most of these patients did not have viremia. One additional patient, studied prospectively, manifested both forms of allograft injury: tubulointerstitial changes occurring two weeks after transplantation and responding to increased immunosuppression, and CMV-associated glomerulopathy occurring seven weeks after transplantation and responding to decreased immunosuppression. We conclude that viremic CMV infection can cause acute glomerular injury and that recovery may be favored by a decreased in immunosuppressants.

Coagulation abnormalities and thrombotic microangiopathy following bone marrow transplantation from HLA-matched unrelated donors in patients with hematological malignancies

“…The causative factors proposed for microangiopathy include total body irradiation, active cytomegalovirus or fungal infection, CsA toxicity, and acute GVHD. [6][7][8][9][10][11][12][13][14][15] In our study, a TBI/AraC/CY preparative regimen was employed for unrelated donor BMT, and TBI/CY regimen for related donor BMT. Thus, we could not exclude the possibility of vascular endothelial damage caused by AraC.…”

“…4 Various causative factors proposed include total body irradiation, acute GVHD, active cytomegalovirus or fungal Correspondence: T Natazuka, Shinseikai-Santoh Clinic, Ro336-85 Nagahisa, Nagahisa-cho, Oda-city, Shimane 694, Japan Received 4 August 1997; accepted 20 November 1997 infection, and cyclosporin A (CsA) toxicity, although no single specific factor has been identified. [6][7][8][9][10][11][12][13][14][15] We have frequently observed BMT-TM in unrelated donor patients. 16 In the present study, we investigated coagulation abnormalities and BMT-TM by comparison of patients receiving related and unrelated donor BMT.…”

The Cell Biology of Cytomegalovirus: Implications for Transplantation

“…"Indirect effects," or systemic effects beyond those attributable to direct viral injury, are mediated by upregulation of specific T and B cell alloimmune responses by innate immune mechanisms (inflammatory mediators, mobilization of antigenpresenting cells with improved antigen presentation, diminished regulatory responses) or by stimulation of alloimmunity by cross-reactive viral antigens with resultant graft injury. The clinical manifestations of human CMV (HCMV) infection vary with the organ transplanted and include CMV syndrome (viremia and neutropenia); graft infection; colitis and retinitis; predisposition to opportunistic infections; posttransplant lymphoproliferative disorders (generally with Epstein-Barr virus [EBV]); and chronic effects including accelerated coronary vasculopathy, bronchiolitis obliterans syndrome and vanishing bile duct syndrome (13)(14)(15). Both direct and indirect effects are often present simultaneously, and the relative clinical contributions of any of these mechanisms are uncertain.…”

Cytomegalovirus Infection in Renal Allograft Biopsy

“…1- 15 The five cases with cytomegalic cells at renal allograft biopsy illustrate a spectrum of infection, varying from florid tubulointerstitial nephritis to the presence of only a few glomerular bearing cytomegalic cells.…”

“…[1][2][3][4][5][6][7][8][9][10] CMV nephritis presenting primarily as viral inclusions or cytomegalic cells in the allograft kidney has been sporadically reported, but detailed clinicopathologic information is available, as reviewed by Birk. [8][9][10][11][12][13][14][15] Typical CMV inclusions have 'owl's eye' nuclear inclusions and eosinophilic inclusions in the cytoplasm of enlarged cells. [1][2][3][4][5][6][7][8][9][10] In addition, three types of atypical inclusions were also found.…”