Eren Sadioglu Rezzan, Eyupoglu Sahin, Erdogmus Siyar, Kumru Sahin Gizem, Yoruk Fugen, Kutlay Sim, Keven Kenan, Erturk Sehsuvar, Sengul Sule
Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
Department of Infectious Disease and Clinic Microbiology, Ankara University School of Medicine, Ankara, Turkey.
Kidney Dis (Basel). 2021 Jan;7(1):57-66. doi: 10.1159/000510153. Epub 2020 Sep 9.
Infections can play an important role in the mortality and morbidity of patients with glomerulonephritis. However, the frequency of infectious complications in primary glomerulonephritis and their burden to the healthcare managements are not clear.
We evaluated the infectious complications in patients with biopsy-proven focal segmental glomerulosclerosis, membranous glomerulonephritis, IgA nephropathy, minimal change disease, membranoproliferative glomerulonephritis, and chronic glomerulonephritis during the last 10 years in a single center. We recorded the demographic, clinical, and laboratory characteristics; treatment modalities; infectious episodes; and infection-related mortality and morbidity of the patients.
Of the patients, 154 (63.6%) received immunosuppressive treatment and 88 (34.4%) were followed up under conservative treatment. Overall, 118 infectious episodes were noted in 64 patients, with an infection rate of 0.20 per patient-year. Total infectious complications were higher in the immunosuppressive group than in the conservative group (42.1 vs. 23.3%, = 0.005). Infection-related hospitalizations were also higher in the immunosuppressive group ( = 0.01). The most frequently infected area was the lungs (15.7%). Although bacterial infections were the most common in both groups, 14.9% of the immunosuppressive group had cytomegalovirus (CMV) replication. Age >50 years (OR 2.19, = 0.03), basal serum albumin <2.5 g/dL (OR 2.28, = 0.02), cyclophosphamide (OR 2.43, = 0.02), and cyclosporine (OR 2.30, = 0.03) were independently associated with experiencing infectious episodes.
Because of high seropositivity for CMV in Turkey, it might be a wise approach to use prophylactic antiviral drugs in patients treated with immunosuppressive treatments. Close monitoring of patients with primary glomerulonephritis, especially those treated with immunosuppressive therapy, is important for reducing infection-related morbidity and mortality.
感染在肾小球肾炎患者的死亡率和发病率中可能起重要作用。然而，原发性肾小球肾炎中感染并发症的发生率及其对医疗管理的负担尚不清楚。
我们评估了在单一中心过去10年中经活检证实为局灶节段性肾小球硬化、膜性肾小球肾炎、IgA肾病、微小病变病、膜增生性肾小球肾炎和慢性肾小球肾炎患者的感染并发症。我们记录了患者的人口统计学、临床和实验室特征、治疗方式、感染发作以及与感染相关的死亡率和发病率。
在这些患者中，154例（63.6%）接受了免疫抑制治疗，88例（34.4%）接受保守治疗随访。总体而言，64例患者共出现118次感染发作，感染率为每人年0.20次。免疫抑制组的总感染并发症高于保守组（42.1%对23.3%，P = 0.005）。免疫抑制组与感染相关的住院率也更高（P = 0.01）。最常感染的部位是肺部（15.7%）。虽然两组中细菌感染最为常见，但免疫抑制组中有14.9%的患者出现巨细胞病毒（CMV）复制。年龄>50岁（比值比[OR]2.19，P = 0.03）、基础血清白蛋白<2.5 g/dL（OR 2.28，P = 0.02）、环磷酰胺（OR 2.43，P = 0.02）和环孢素（OR 2.30，P = 0.03）与感染发作独立相关。
由于土耳其CMV血清阳性率较高，对于接受免疫抑制治疗的患者使用预防性抗病毒药物可能是一种明智的方法。密切监测原发性肾小球肾炎患者，尤其是接受免疫抑制治疗的患者，对于降低与感染相关的发病率和死亡率很重要。
