Pediatric Nephrologists Author Case Study on Pediatric Patient with CMV-Associated Collapsing FSGS after Kidney Transplantation

Paper presents the first-reported pediatric case of this serious complication

Pediatric nephrologists from Hackensack Meridian Children’s Health have published a case study of the first-reported pediatric patient to develop cytomegalovirus (CMV)-induced collapsing focal segmental glomerulosclerosis (FSGS) after kidney transplantation. CMV is known to rarely induce FSGS among adults and is a significant cause of morbidity among immunocompromised patients who have undergone kidney transplantation.

Namrata G. Jain, M.D., Madeline F. E. Parr, M.D., Guillermo Hidalgo, M.D., Kenneth V. Lieberman, M.D., Michael J Goldstein, M.D. and Aryeh Z. Baer, M.D., were among the authors of the case study, published in Pediatric Transplantation, the official journal of the International Pediatric Transplant Association.

“We demonstrate the first case of successfully managed CMV collapsing FSGS in a pediatric kidney transplant patient,” said Dr. Parr. “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.”

Collapsing FSGS is associated with various etiologies including infectious, such as human immunodeficiency virus (HIV), COVID-19, Epstein-Barr virus (EBV), and CMV, in addition to genetic mutations in the APOL1 gene, malignancies, and ischemic events. Among patients who have undergone kidney transplantation, immunosuppression increases the risk for infectious insult from CMV, which may predispose patients to collapsing FSGS.

“In patients with signs of graft failure, it is imperative to evaluate for opportunistic infections such as CMV, as early detection and prompt treatment with lowering immunosuppression and with antiviral medication are integral to prolonging allograft survival,” said Dr. Hidalgo.