Cytomegalovirus disease in patients with glomerular diseases treated by immunosuppressive treatment

Abstract

CMV disease is not an uncommon complication in patients with glomerular diseases treated by immunosuppression. Further prospective studies and prophylaxis should be addressed in future studies, including particular groups of patients.

Epidemiology and risk factors for cytomegalovirus infection in glomerular diseases treated with immunosuppressive therapy

“…High CMV reactivation rates of up to 60% in post-transplant patients and detrimental direct and indirect effects of CMV infection on allograft function have led to clinical practice guidelines for universal prophylaxis to prevent CMV reactivation in solid organ transplant recipients. [26][27][28] The CMV infection rates among GN patients in the Turkish cohort and our patients were lower, 14 possibly reflecting the less intensive IS therapy given to GN patients compared with solid organ transplant recipients. 29 However, CMV disease in GN is still associated with significant morbidity and mortality.…”

“…There are few studies among GN cohorts for comparison. CMV disease was found in one‐fifth of 133 Turkish patients with glomerular diseases and mean (±2SD) eGFR 82 ± 55 mL/min treated with either corticosteroids alone or in combination with CYC, cyclosporine, MMF or azathioprine . The study did not differentiate the type of corticosteroid (MP vs prednisolone); nor evaluate the role of other potent IS, such as RTX, commonly used to treat GN nowadays.…”

“…Our finding that higher serum creatinine was associated with CMV infections among patients with glomerular disease is consistent with that from Celebi et al [adjusted OR 1.37 (95% CI 1.04, 1.82), P = 0.02] and among patients with kidney transplants. 14,23 Uraemia can cause metabolic and functional abnormalities in polymorphonuclear leucocytes and heavy proteinuria may result in hypogammaglobulinemia. 24 Both eGFR and albuminuria were found to be independently associated with increased infection-related mortality in patients with pre-dialysis CKD.…”

“…Use of immunosuppressive therapy has improved patient and renal survival . However, immunosuppressants (IS) like methylprednisolone (MP) and cyclophosphamide (CYC) may be risk factors for CMV infection . More recently, rituximab (RTX) has been successfully used to treat certain types of GN.…”

“…12,13 However, immunosuppressants (IS) like methylprednisolone (MP) and cyclophosphamide (CYC) may be risk factors for CMV infection. 8,14,15 More recently, rituximab (RTX) has been successfully used to treat certain types of GN. In patients with haematological malignancies and kidney transplant, use of RTX is associated with increased rates of CMV infection.…”