AJKD electronic pagesCase reportsPosttransplantation cytomegalovirus-induced recurrence of atypical hemolytic uremic syndrome associated with a factor H mutation: Successful treatment with intensive plasma exchanges and ganciclovir
Section snippets
Case report
The patient belongs to a family of 5 children, 3 of whom have presented with atypical HUS. The eldest affected child has lost 2 allografts to recurrent HUS and is currently treated by hemodialysis. The identical twin sister of the patient described in this report has normal kidney function 3 years after presentation. She is treated with regular prophylactic PE. In all 3 siblings, von Willebrand factor-cleaving protease activity is normal and no evidence of complement activation, as assessed by
Discussion
CMV infection in renal transplant recipients has both renal and systemic effects. 15 CMV can impair allograft function through the development of a transplant glomerulopathy 16, 17 and by predisposing to acute rejection and chronic allograft nephropathy. 18, 19 De novo thrombotic microangiopathy in association with CMV infection has also been reported in 3 adult transplant recipients 12, 20; in one, graft function did not recover. CMV increases the expression of endothelial adhesion molecules
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Dr Goodship is supported by the National Kidney Research Fund of the United Kingdom.