Servicio de Nefrología, Hospital Universitario de Badajoz, Badajoz, España.
Servicio de Nefrología, Hospital Universitario de Badajoz, Badajoz, España.
Med Clin (Barc). 2023 Mar 10;160(5):199-202. doi: 10.1016/j.medcli.2022.07.009. Epub 2022 Aug 26.
Renal involvement due to necrotizing pauci-immune glomerulonephritis (PIGN) associated with small vessel vasculitis requires the use of immunosuppressive. Associated side effects include an increased risk of infectious processes, such as cytomegalovirus (CMV) disease; therefore, there are no recommendations on its management in the various clinical practice guidelines (CPG).
To study the incidence of CMV disease and its determinants.
Patients with histological diagnosis of necrotizing pauci-immune glomerulonephritis in the last 10 years, who were determined the viral load of CMV, analyzing the determinants of its occurrence.
Forty-four biopsies were performed during the study period. Eleven patients (25%) developed CMV disease; all had received immunosuppressive treatment. Four (30.8%) died during admission. The determinants of CMV disease were age (for every 10 years OR: 3.0, 95% CI: 1.0-8.9, p = 0.012), and plasma albumin (for each g/L OR: 0.8, 95% CI: 0.6-1.0, p = 0.012).
The incidence of CMV disease in immunocompromised patients due to PIGN is high, with high mortality. It would be necessary to include strategies in the CPGs to prevent it.
与小血管血管炎相关的坏死性少免疫性肾小球肾炎（PIGN）引起的肾损害需要使用免疫抑制剂。相关的副作用包括感染过程（如巨细胞病毒（CMV）疾病）的风险增加；因此，各种临床实践指南（CPG）中没有关于其管理的建议。
研究 CMV 疾病的发生率及其决定因素。
在过去 10 年中，对组织学诊断为坏死性少免疫性肾小球肾炎的患者进行了 CMV 病毒载量检测，并分析了其发生的决定因素。
在研究期间共进行了 44 次活检。11 名患者（25%）发生了 CMV 疾病；所有患者均接受了免疫抑制治疗。其中 4 名（30.8%）在住院期间死亡。CMV 疾病的决定因素是年龄（每增加 10 岁 OR：3.0，95%CI：1.0-8.9，p = 0.012）和血浆白蛋白（每增加 1g/L OR：0.8，95%CI：0.6-1.0，p = 0.012）。
由于 PIGN 导致免疫功能低下患者的 CMV 疾病发生率较高，死亡率较高。CPG 中需要纳入预防 CMV 疾病的策略。
