Kumru Sahin Gizem, Eyupoglu Sahin, Eren Sadioglu Rezzan, Cinar Gule, Ates Kenan, Erturk Sehsuvar, Nergizoglu Gokhan, Sengul Sule, Kutlay Sim, Keven Kenan
Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
Department of Nephrology, Ministry of Health Van Education Research Hospital, Van, Turkey.
Int Urol Nephrol. 2022 May;54(5):1091-1096. doi: 10.1007/s11255-021-02973-w. Epub 2021 Aug 16.
Cytomegalovirus infection is an important complication in immunocompromised patients. As few studies have shown that cyclophosphamide treatment is a risk factor for cytomegalovirus infection in patients with glomerulonephritis, we aimed to describe the frequency and risk factors of cytomegalovirus infection in glomerulonephritis patients treated with cyclophosphamide.
We prospectively recruited 43 cytomegalovirus seropositive patients with glomerulonephritis treated with cyclophosphamide. We screened all patients for viral DNA monthly during treatment. Patients were compared for age, sex, glomerular pathology, renal function and clinical status regarding development of cytomegalovirus infection before and after the treatment.
Cytomegalovirus infection was detected in 10 (23.3%) patients, most commonly within the first 2 months of cyclophosphamide treatment. All patients recovered without any cytomegalovirus-related complications. Patients with cytomegalovirus infection had higher serum creatinine (4.2 ± 3.2 vs. 1.9 ± 1.8 mg/dl, p = 0.006) and lower estimated glomerular filtration rate (29 ± 11 vs. 65 ± 8 ml/min/1.73 m, p = 0.016) at diagnosis compared with cytomegalovirus infection non-occurred patients. In addition, number of patients presented with rapidly progressive glomerulonephritis were higher in cytomegalovirus infection group (80.0% vs. 27.3%, p = 0.007). Moreover, cytomegalovirus infection was associated with prolonged hospital stay (54 ± 7 vs. 29 ± 6 days, p = 0.027).
Cytomegalovirus infection is a common complication in glomerulonephritis patients treated with cyclophosphamide in this prospective study. Routine monitoring and prophylaxis should be considered for these high-risk patients.
巨细胞病毒感染是免疫功能低下患者的一种重要并发症。由于很少有研究表明环磷酰胺治疗是肾小球肾炎患者巨细胞病毒感染的危险因素，我们旨在描述接受环磷酰胺治疗的肾小球肾炎患者巨细胞病毒感染的发生率及危险因素。
我们前瞻性招募了43例接受环磷酰胺治疗的巨细胞病毒血清学阳性的肾小球肾炎患者。在治疗期间每月对所有患者进行病毒DNA筛查。比较患者治疗前后巨细胞病毒感染发生情况的年龄、性别、肾小球病理、肾功能及临床状态。
10例（23.3%）患者检测到巨细胞病毒感染，最常见于环磷酰胺治疗的前2个月内。所有患者均康复，无任何与巨细胞病毒相关的并发症。与未发生巨细胞病毒感染的患者相比，发生巨细胞病毒感染的患者在诊断时血清肌酐水平更高（4.2±3.2 vs. 1.9±1.8mg/dl，p = 0.006），估计肾小球滤过率更低（29±11 vs. 65±8ml/min/1.73m²，p = 0.016）。此外，快速进展性肾小球肾炎患者在巨细胞病毒感染组中的比例更高（80.0% vs. 27.3%，p = 0.007）。而且，巨细胞病毒感染与住院时间延长有关（54±7 vs. 29±6天，p = 0.027）。
在这项前瞻性研究中，巨细胞病毒感染是接受环磷酰胺治疗的肾小球肾炎患者的常见并发症。对于这些高危患者应考虑进行常规监测和预防。
