Open AccessFOSCARNET-INDUCED CRYSTALLINE GLOMERULONEPHRITIS WITH NEPHROTIC SYNDROME AND ACUTE RENAL FAILURE AFTER KIDNEY TRANSPLANTATION
Author(s) -
Gilbert Zanetta,
Laurence Maurice-Estepa,
Christiane Mousson,
E Justrabo,
Michel Daudon,
G Rifle,
Y. Tanter
Publication year - 1999
Publication title -
transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.45
H-Index - 204
eISSN - 1534-6080
pISSN - 0041-1337
DOI - 10.1097/00007890-199905270-00016
Subject(s) - foscarnet , medicine , fanconi syndrome , nephrotic syndrome , nephrotoxicity , transplantation , kidney , biopsy , kidney transplantation , renal function , renal biopsy , cytomegalovirus , glomerulonephritis , nephrology , pathology , urology , gastroenterology , immunology , ganciclovir , human immunodeficiency virus (hiv) , viral disease , human cytomegalovirus , herpesviridae , virus
Foscarnet nephrotoxicity has been reported to be associated with acute tubulointerstitial nephritis. Crystals in glomerular capillary lumens have also been observed in patients with acquired immunodeficiency syndrome who were treated with foscarnet for cytomegalovirus disease. We describe a kidney transplant recipient who developed a nephrotic syndrome with microscopic hematuria and nonoliguric acute renal failure within 15 days after starting foscarnet therapy for cytomegalovirus infection. A kidney biopsy specimen showed the presence of crystals in all glomeruli and in proximal tubules. Fourier transform infrared microscopy analysis demonstrated that crystals were made from several forms of foscarnet salts: mixed calcium and sodium salts, and unchanged trisodium foscarnet salts. Renal function and proteinuria spontaneously improved, and a second transplant biopsy performed 8 months after the first one revealed fibrotic organization of half of the glomeruli and of interstitial tissue, and crystal vanishing. We were thus able to provide proof of the possible precipitation of foscarnet in a transplanted kidney.