Renal changes in cytomegalovirus infection.

Renal biopsy was performed in 20 graft recipients to characterise the histological features associated with poor renal function concomitant with cytomegalovirus infection (CMV). Eight patients presented with proteinuria, three had microscopic haematuria at onset, and five were hypertensive. Infection was accompanied by clinical symptoms (fever, leucopenia, mild hepatic damage, or pneumonitis) in 15 patients. In all cases, serum creatinine was greater than 2 mg/dl. All patients showed some glomerular alteration on biopsy, and vascular changes were the predominant feature in seven cases. IgM and complement (C3) were found in the glomeruli of five of six patients studied by immunofluorescence. Serum creatinine was below 2 mg/dl at ten to 26 months following the infectious episode in four patients and between 2-3 mg/dl in three patients. The remaining 13 developed irreversible rejection and end-stage renal failure. We conclude that CMV, the most commonly recognised viral infection following transplantation, can cause renal changes, both glomerular (CMV glomerulopathy) and vascular (transplant vasculopathy), which may induce poor graft function.