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

Lim, Cynthia Ciwei; Tung, Yu Tzu; Tan, Ban Hock; Lee, Puay Hoon; Mok, Irene; Oon, Lynette; Chan, Kwai Peng; Choo, Jason Chon Jun

doi:10.1111/nep.13071

Cited by 15 publications

(4 citation statements)

References 27 publications

(56 reference statements)

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“…Cyclophosphamide suppresses lymphocyte proliferation and function, thus increasing the risk of CMV reactivation. Cyclophosphamide use was found to be a risk factor for the reactivation of CMV in glomerulonephritis patients [31]. While the mechanism of action of these immunosuppressive drugs used in treatment of SLE makes development of CMV infection highly probable, other considerations such as the immunosuppression dose, duration of treatment and combination therapy with other immunosuppressive drugs may play a bigger role in the pathogenesis of CMV infection and disease in SLE patients.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for cytomegalovirus disease in systemic lupus erythematosus (SLE): a systematic review

et al. 2019

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Background: Cytomegalovirus (CMV) is an opportunistic pathogen causing reactivation and disease in Systemic Lupus Erythematosus (SLE) patients. This study aims to systematically review the literature for risk factors associated with CMV disease in SLE patients, in order to identify those more susceptible to CMV infection during their treatment.Methods: A systematic review was conducted on 4 different search engines and via hand search until May 2017. Studies were included after quality assessment via the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (HTA KMET).Results: Two studies on CMV disease were included. Elevated CMV viral load, higher steroid doses, use of immunosuppressants and disease duration were the most commonly associated risk factors for CMV disease. Conclusion:High CMV viral loads, longer SLE disease duration and higher steroid doses were associated with CMV disease. Further studies studying the risk of treatment drugs and role of interventions in the development of CMV infection are needed.

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Section: Discussionmentioning

confidence: 99%

Risk factors for cytomegalovirus disease in systemic lupus erythematosus (SLE): a systematic review

et al. 2019

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“…Glomerular diseases are still common causes of end-stage renal disease (ESRD), a global health epidemic affecting more than 2 million people worldwide [1][2][3][4]. Many glomerular diseases are immunologically mediated disorders [1,[5][6][7][8], and immunosuppressive medications put glomerular disease patients at a high risk of various infections, such as pneumonia, Mycobacterium tuberculosis and hepatitis B virus reactivation, which contribute to the progression of disease per se and mortality [9][10][11][12][13][14]. In recent years, accumulating data have shown an increased rate of opportunistic infections in glomerular disease patients with longterm use of glucocorticoids and (or) immunosuppressive agents, especially in nephrotic syndrome, IgA nephropathy, lupus nephritis and vasculitis patients [14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.

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“…As clinicians managing patients with glomerulonephritis, it is concerning that the domain item mean score was lowest for appraising health information and nearly a quarter of responders perceived difficulty related to accessing, appraising and applying information on different treatment options to make therapeutic decisions (items 2, 10, and 13). Management of glomerulonephritis often involves discussion regarding the clinical trajectory of the condition and need for potent immunosuppressants to achieve remission, but these medications may be associated with side effects such as infectious and metabolic complications [ 3 , 4 , 22 ]. Patients involved in the shared decision-making may find weighing the relative benefits and risks of the myriad and complex therapeutic options considerably daunting.…”

Section: Discussionmentioning

confidence: 99%

Health Literacy in Glomerulonephritis and Renal Vasculitis Attending Nephrology Clinics

et al. 2021

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Aims: Glomerulonephritis is one of the leading causes of progressive chronic kidney disease worldwide and treatment requires shared decision-making to improve self-care and plan immunosuppressant therapy. However, information on health literacy (HL) in patients with glomerulonephritis is scanty. We aimed to assess HL in our multiethnic population with glomerulonephritis. Methods: Single-center cross-sectional study of patients with glomerulonephritis receiving induction immunosuppressants at the ambulatory nephrology clinic and who completed the anonymized self-administered HLS-EU-47 questionnaire. The standardized HL index and domain item mean scores were compared with participant sociodemographic characteristics. Results: Among 65 patients who attend the clinics over a month, 27 agreed to participate in the survey. After excluding responses with significant missing information, we included 23 participants (16 Chinese, 4 Malay, 2 Indian, and 1 other ethnicity) in the analysis. The median age was 39 (interquartile range 27, 60 years). The median general HL index was 26.2 (19.8, 29.8). The item mean scores were 2.64 (2.43, 2.77), 2.45 (2.09, 2.72), 2.33 (2.17, 2.58), and 2.50 (2.25, 2.75) for the domains of accessing, understanding, appraising, and applying health-care-related information, respectively. Male patients had significantly higher HL indices and higher scores for accessing and appraising health information, while higher personal income was significantly associated with higher score for applying health knowledge. Conclusion: Patients with glomerulonephritis had lowest HL in the domain of appraising health information. Further research on targeted interventions to improve the HL in appraising treatment options and vaccinations in patients with glomerulonephritis is required.

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

Abstract: Cytomegalovirus infection is common in GN patients receiving potent IS. Surveillance and possibly anti-viral prophylaxis should be considered for high-risk patients.

Cited by 15 publications

References 27 publications

Risk factors for cytomegalovirus disease in systemic lupus erythematosus (SLE): a systematic review

Risk factors for cytomegalovirus disease in systemic lupus erythematosus (SLE): a systematic review

Nocardiosis in glomerular disease patients with immunosuppressive therapy

Health Literacy in Glomerulonephritis and Renal Vasculitis Attending Nephrology Clinics

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