ABSTRACT
Membranous nephritis (MN) is a rare form of glomerulonephritis in childhood, with an incidence of 0.8 to 6.7% based on renal biopsy specimens. Although the disease is considered to be idiopathic in the majority of cases, especially in adults, MN has been associated with various infectious agents, such as hepatitis Beta virus. The natural history of MN in childhood remains unknown because of its rarity, and to the best of our knowledge, no case of MN linked to cytomegalovirus (CMV) infection in an immunocompetent child has been described to date. We report here a 19-month-old female infant who presented with a maculopapular rash, fever, and nephritic-nephrotic syndrome. Virology tests for infectious diseases revealed a recent CMV infection. The renal biopsy findings were compatible with MN, while PCR analysis of the renal tissue specimen was positive for CMV DNA. Antiviral treatment (ganciclovir) resulted in full remission of proteinuria and hematuria. Two years after the initial diagnosis, the child remains well and asymptomatic without clinical or laboratory evidence of the disease.
Subject(s)
Cytomegalovirus Infections/complications , Cytomegalovirus Infections/pathology , Cytomegalovirus/isolation & purification , Glomerulonephritis, Membranous/pathology , Glomerulonephritis, Membranous/virology , Antibodies, Viral/blood , Antiviral Agents/therapeutic use , Biopsy , Cytomegalovirus/genetics , Cytomegalovirus/immunology , Cytomegalovirus Infections/drug therapy , DNA, Viral/analysis , Female , Ganciclovir/therapeutic use , Glomerulonephritis, Membranous/drug therapy , Hematuria/drug therapy , Humans , Infant , Kidney/pathology , Kidney/virology , Proteinuria/drug therapy , Renal Insufficiency/drug therapy , Renal Insufficiency/pathology , Renal Insufficiency/virology , Treatment OutcomeABSTRACT
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (AT II) receptor blockers (ARBs) are widely used antihypertensives with well-recognized renoprotective and cardioprotective effects. Although treatment with these agents generally does not result in adverse metabolic consequences, their use during human pregnancy has been associated with negative reactions. Here we report a premature baby with a history of oligohydramnios and maternal exposure to the ARB olmesartan medoxomil who was transferred to our institution with acute renal failure. Conservative treatment with diuretics and meticulous management of fluids and electrolytes resulted in an improvement in renal function in the patient. We conclude that olmesartan medoxomil may cause reversible renal failure in premature neonates.
