Cytomegalovirus Glomerulopathy in a Kidney Allograft With Response to Oral Valganciclovir

Cytomegalovirus is an important viral pathogen in the kidney transplant population. Reports of direct cytopathic effects of cytomegalovirus in the kidney allograft are infrequent, with the majority of earlier reports highlighting tubulointerstitial involvement. We report a 58-year-old man who presented with an acute decrease in kidney allograft function 3 months posttransplantation. At presentation, both cytomegalovirus and polyomavirus blood polymerase chain reaction results were positive. Biopsy showed predominant glomerular endothelial involvement by cytomegalovirus with positive immunohistochemistry results. Polyomavirus was not detected in the biopsy specimen. He was treated with oral valganciclovir and a decrease in immunosuppression. He had a complete response, with clearance of viremia and return of allograft function to baseline. Recent reports of glomerular involvement may reflect changing practices in antiviral chemoprophylaxis and immunosuppressive regimen. Oral valganciclovir may have a role in the treatment of patients with mild viremia with tissue-invasive kidney disease.