Lopez V, Sola E, Gutierrez C, Burgos D, Cabello M, García I, Florez P, Lopez J, Gonzalez-Molina M
Nephrology, Carlos Haya Hospital, Malaga, Spain.
Transplant Proc. 2006 Oct;38(8):2412-3. doi: 10.1016/j.transproceed.2006.08.067.
Polyomavirus-associated nephropathy (PVAN) is an important cause of kidney dysfunction and graft loss. Different treatment regimens have been used, including low-dose intravenous cidofovir. Anterior uveitis, a complication of this treatment, has been reported after its use in patients with cytomegalovirus-associated retinitis. We analyzed the incidence and associated risk factors for this disorder in patients with PVAN.
The study included 14 kidney-transplant patients who had received low doses of cidofovir after being diagnosed with PVAN.
Five (35%) patients developed an episode of anterior uveitis. The mean number of cidofovir doses given was 6.8 +/- 1.6 as compared with 9.1 +/- 2.1 in patients who did not develop the disease. Creatinine clearance at diagnosis of the nephropathy and after terminating treatment was lower in the uveitis patients, who had a graft survival of 40% versus 100% in the patients who did not develop eye involvement. Treatment was suspended in the affected patients, with complete resolution in 80% after the administration of topical corticoids and cycloplegics.
Anterior uveitis secondary to low-dose treatment with cidofovir is a common complication in patients with PVAN and is associated with the degree of renal involvement. In the absence of larger studies, cidofovir should be used with caution in patients with creatinine clearance below 30 mL/min.
多瘤病毒相关性肾病（PVAN）是导致肾功能不全和移植肾失功的重要原因。已采用了不同的治疗方案，包括小剂量静脉注射西多福韦。前葡萄膜炎是该治疗的一种并发症，在用于巨细胞病毒相关性视网膜炎患者后已有报道。我们分析了PVAN患者中这种疾病的发生率及相关危险因素。
本研究纳入了14例诊断为PVAN后接受小剂量西多福韦治疗的肾移植患者。
5例（35%）患者发生了前葡萄膜炎发作。发生葡萄膜炎的患者接受西多福韦的平均剂量为6.8±1.6剂，而未发生该疾病的患者为9.1±2.1剂。葡萄膜炎患者在肾病诊断时及治疗终止后的肌酐清除率较低，其移植肾存活率为40%，而未发生眼部病变的患者为100%。对受累患者暂停治疗，局部应用皮质类固醇和睫状肌麻痹剂后80%完全缓解。
小剂量西多福韦治疗继发的前葡萄膜炎是PVAN患者的常见并发症，且与肾脏受累程度相关。在缺乏更大规模研究的情况下，肌酐清除率低于30 mL/min的患者应谨慎使用西多福韦。
