Treatment of parvovirus B19 viremia to facilitate kidney transplantation in a patient with collapsing glomerulopathy.

Clinical Nephrology. Case Studies Pub Date : 2020-05-29 eCollection Date: 2020-01-01 DOI:10.5414/CNCS110113
Vinay Nair, Nicholas Jandovitz, Kenar D Jhaveri, David Hirschwerk, Elliot Grodstein, Vanesa Bijol, Ernesto Molmenti, Lewis Teperman
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引用次数: 3

Abstract

Collapsing glomerulopathy (CG) is a severe form of glomerulopathy which results in nephrotic syndrome and often ensues in rapid progression to end-stage kidney disease (ESKD). Although most commonly a result of HIV infection, other conditions such as parvovirus B19 (PB19) infection have been associated with CG. We present a case of an 18-year-old male with CG associated with PB19 infection who was heterozygous for APOL1 G1 and G2 genetic variants. In an attempt to treat, he was started on intravenous immunoglobulin (IVIg), however rapidly progressed to ESKD. During workup for a living donor kidney transplant he was found to have persistent low-grade PB19 viremia. Despite having no major immunodeficiency and given subsequent courses of IVIg, viremia continued to persist. In a final attempt to eradicate the PB19 we began treatment with cidofovir, an antiviral agent with in vitro efficacy against PB19. Subsequent to initiation of cidofovir, PB19 viremia slowly cleared after which he received a living unrelated kidney transplant. The patient had an early cellular rejection treated with rabbit antithymocyte globulin after which he recovered kidney function without signs of recurrent CG. Our case report suggests efficacy of IVIg and cidofovir for persistent PB19 infection in ESKD to allow subsequent transplantation, while minimizing the risk of recurrent CG.

Abstract Image

Abstract Image

治疗细小病毒B19病毒血症促进塌陷肾小球病患者肾移植。
塌陷性肾小球病(CG)是肾小球病的一种严重形式,可导致肾病综合征,并经常迅速发展为终末期肾病(ESKD)。虽然最常见的是HIV感染的结果,但其他疾病如细小病毒B19 (PB19)感染也与CG有关。我们报告了一例18岁男性CG与PB19感染相关的病例,他是APOL1 G1和G2遗传变异的杂合子。在尝试治疗时,他开始静脉注射免疫球蛋白(IVIg),但迅速发展为ESKD。在活体供体肾移植的检查中,他被发现有持续的低度PB19病毒血症。尽管没有重大的免疫缺陷,并给予后续的免疫球蛋白疗程,病毒血症仍持续存在。在根除PB19的最后尝试中,我们开始使用西多福韦进行治疗,这是一种体外对PB19有效的抗病毒药物。在开始使用西多福韦后,PB19病毒血症慢慢清除,之后他接受了活体非亲属肾移植。患者早期有细胞排斥反应,经兔抗胸腺细胞球蛋白治疗后肾功能恢复,无复发性CG征象。我们的病例报告表明,IVIg和西多福韦对ESKD中持续的PB19感染有效,允许随后的移植,同时最小化复发性CG的风险。
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