PMC5350387_01
Foscarnet nephropathy in the kidney transplant. (a) Masson's trichrome staining (x200) showed intraglomerular crystalline precipitation obstructing the capillaries and crushing the mesangium together with fibrinoid thrombi. (b) Jones methenamine silver staining (x400) also revealed FOS crystals within the glomerular capillaries. (c) Masson's trichrome staining (x200) showed crystals that resembled short sticks with angular edges in the tubular lumen. (d) Jones methenamine silver staining (x400) also revealed FOS crystals within the tubular lumen.
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fig1
No sign of acute rejection or CMV transplant infection was noted on the biopsy (Figure 1).
Course of multiresistant CMV disease. (a) Evolution of CMV antigenemia (red line) and kidney transplant function (serum creatinine level, blue line) together with antiviral therapies and genotypic mutations. PC: positive cells/200000 polymorphonuclear leukocytes. GCV: ganciclovir. CDV: cidofovir. (b) Evolution of blood ciclosporin levels (black line) and lymphocytes counts (blue line).
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fig2
A new two-month course of intravenous FOS (50 mg/kg/d, dose tailored to decreased glomerular filtration rate) was necessary to achieve a complete resolution of CMV infection (negative antigenemia and PCR) without any new FOS nephropathy.  Figure 2 describes the course of the CMV disease together with the course of immunosuppression and blood lymphocyte counts.