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Irreversible glomerular lesions induced by crystal precipitation in a renal transplant after foscarnet therapy for cytomegalovirus infection. Histopathology 1999 Apr;34(4):365-9

Date

05/07/1999

Pubmed ID

10231404

DOI

10.1046/j.1365-2559.1999.00642.x

Scopus ID

2-s2.0-0032893278 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

AIMS: Foscarnet is an antiviral agent used to treat cytomegalovirus infection in AIDS patients and in transplant recipients. In most cases, foscarnet induces reversible tubulo-interstitial lesions which can be avoided by correct hydration. We report the first case of crystal foscarnet precipitation within glomerular capillaries in a renal transplant.

METHODS AND RESULTS: The recipient, a 49-year-old man, developed a nephrotic syndrome with haematuria and an acute renal failure after foscarnet therapy for cytomegalovirus (CMV) infection. The polarization examination of the first graft biopsy revealed the presence of birefringent crystals within glomeruli and tubules. Infrared analysis attested to the presence of trisodium foscarnet salts and mixed sodium calcium salts coloured by Von Kossa's reaction. A second biopsy showed glomerular sclerosis, interstitial fibrosis, tubular atrophy and crystal vanishing. Polymerase chain reaction (PCR) in situ applied to this biopsy confirmed the diagnosis of cytomegalovirus infection.

CONCLUSIONS: These adverse effects might be the result of a toxic synergy between foscarnet and other drugs. In cases with crystalline precipitation, graft biopsy remains the best mean of diagnosis and follow-up of glomerular damage.

Author List

Justrabo E, Zanetta G, Martin L, Assem M, Mousson C, Maurice-Estepa L, Rifle G, Tanter Y

Author

Mahfoud Assem PharmD Associate Professor in the School of Pharmacy Administration department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Biopsy
Birefringence
Crystallization
Cytomegalovirus Infections
Foscarnet
Humans
Kidney Diseases
Kidney Glomerulus
Kidney Transplantation
Male
Middle Aged