Hyalinose segmentaire et focale collapsante secondaire au cytomégalovirus : à  propos d'un cas

Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome in child and adult. The collapsing forms are of poor renal prognosis and are usually secondary to viral infections with, first and foremost, the human immunodeficiency virus. Among other viral etiologies, cytomegalovirus (CMV) is an uncommon cause. We report a case of a 32 years-old patient with collapsing focal segmental glomerulosclerosis induced by cytomegalovirus with initial acute renal failure and proteinuria at 12.4 g/24 h. The treatment associated ganciclovir during 7 days followed by valganciclovir during 14 days and steroids at 1 mg/kg/day. Renal function improved and proteinuria decreased with this treatment. Proteinuria increase again 3 weeks after valganciclovir discontinuation while CMV Polymerase chain reaction (PCR) was positive. Therefore, valganciclovir has been resumed allowing renal function normalization and decrease in proteinuria to 4 g/24 h after negative CMV PCR assay after 15 weeks. Anti-CMV therapy combined with steroids seems to provide a renal response in case of FSGS induced by CMV even if long-term prognosis stays uncertain.