Lim Cynthia C, Tung Yu Tzu, Tan Ban Hock, Lee Puay Hoon, Mok Irene, Oon Lynette, Chan Kwai Peng, Choo Jason Cj
Department of Renal Medicine, Singapore General Hospital, Singapore.
Department of Pharmacy, Singapore General Hospital, Singapore.
Nephrology (Carlton). 2018 Jul;23(7):676-681. doi: 10.1111/nep.13071.
Cytomegalovirus (CMV) infections are associated with morbidity and mortality. We aimed to describe the epidemiology, risk factors and outcomes of CMV infection among patients with glomerulonephritis (GN) who received potent immunosuppressants (IS).
Single-centre retrospective study of adults with biopsy-proven GN prescribed methylprednisolone (MP), cyclophosphamide (CYC) or rituximab (RTX). Primary endpoint was CMV infection defined by significant CMV antigenaemia (>10 positive cells in 10 cells) or viraemia (>2000 copies/mL). Death was related to CMV if CMV infection occurred within the same hospitalization as death.
Ninety-four patients were studied. CYC was prescribed in 65% and MP in 71% of the cohort. Only two patients received RTX and 15 patients received plasma exchanges (PEX). Median follow up was 31.9 (IQR: 13.7, 53.6) months. CMV infection occurred in 13 patients (13.8%) at 1.3 (0.6, 3.0) months from biopsy. Patients with CMV infection had higher serum creatinine [404 (272, 619) vs. 159 (93, 317) μmol/L, P < 0.001] and greater proteinuria [UPCR 7.5, (4.8, 11.8) vs. 4.2 (2.3, 8.4) g/g, P = 0.02] than those who did not have CMV infection. Also, more patients received CYC (92% vs. 60%, P = 0.03), RTX (15% vs. 0, P = 0.02) and PEX (38% vs. 12%, P = 0.01) than those who did not have CMV infection. Two patients had CMV-related deaths.
Cytomegalovirus infection is common in GN patients receiving potent IS. Surveillance and possibly anti-viral prophylaxis should be considered for high-risk patients.
巨细胞病毒（CMV）感染与发病率和死亡率相关。我们旨在描述接受强效免疫抑制剂（IS）的肾小球肾炎（GN）患者中CMV感染的流行病学、危险因素及转归。
对经活检证实为GN且处方了甲泼尼龙（MP）、环磷酰胺（CYC）或利妥昔单抗（RTX）的成人患者进行单中心回顾性研究。主要终点为CMV感染，定义为显著的CMV抗原血症（10个细胞中有>10个阳性细胞）或病毒血症（>2000拷贝/mL）。如果CMV感染发生在与死亡相同的住院期间，则死亡与CMV相关。
共研究了94例患者。队列中65%的患者处方了CYC，71%的患者处方了MP。仅2例患者接受了RTX，15例患者接受了血浆置换（PEX）。中位随访时间为31.9（四分位间距：13.7，53.6）个月。13例患者（13.8%）在活检后1.3（0.6，3.0）个月发生CMV感染。发生CMV感染的患者血清肌酐水平更高[404（272，619） vs. 159（93，317）μmol/L，P<0.001]，蛋白尿更多[尿蛋白肌酐比值7.5，（4.8，11.8） vs. 4.2（2.3，8.4）g/g，P = 0.02]，高于未发生CMV感染的患者。此外，与未发生CMV感染的患者相比，更多发生CMV感染的患者接受了CYC（92% vs. 60%，P = 0.03）、RTX（15% vs. 0，P = 0.02）和PEX（38% vs. 12%，P = 0.01）。2例患者死于CMV相关原因。
CMV感染在接受强效IS的GN患者中很常见。对于高危患者应考虑进行监测并可能采取抗病毒预防措施。
