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

• Published in: Nephrology (Carlton, Vic.) Vic.), 2018-07, Vol.23 (7), p.676-681
• Main Authors: Lim, Cynthia C, Tung, Yu Tzu, Tan, Ban Hock, Lee, Puay Hoon, Mok, Irene, Oon, Lynette, Chan, Kwai Peng, Choo, Jason CJ
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biopsy; Creatinine; Cyclophosphamide; Cytomegalovirus; Cytomegalovirus - immunology; Cytomegalovirus - pathogenicity; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - immunology; Cytomegalovirus Infections - mortality; Epidemiology; Female; Glomerulonephritis; Glomerulonephritis - diagnosis; Glomerulonephritis - drug therapy; Glomerulonephritis - immunology; Glomerulonephritis - mortality; Hospital Mortality; Host-Pathogen Interactions; Humans; Immunocompromised Host; Immunosuppressive agents; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunotherapy; Infections; Male; Methylprednisolone; Middle Aged; Monoclonal antibodies; Morbidity; Opportunistic Infections - diagnosis; Opportunistic Infections - epidemiology; Opportunistic Infections - immunology; Opportunistic Infections - mortality; Prophylaxis; Proteinuria; Retrospective Studies; Risk Assessment; Risk Factors; Rituximab; Singapore; Time Factors; Viremia
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13071

Aim Cytomegalovirus (CMV) infections are associated with morbidity and mortality. We aimed to describe the epidemiology, risk factors and outcomes of CMV infection among patients with glomerulonephritis (GN) who received potent immunosuppressants (IS). Methods Single‐centre retrospective study of adults with biopsy‐proven GN prescribed methylprednisolone (MP), cyclophosphamide (CYC) or rituximab (RTX). Primary endpoint was CMV infection defined by significant CMV antigenaemia (>10 positive cells in 106 cells) or viraemia (>2000 copies/mL). Death was related to CMV if CMV infection occurred within the same hospitalization as death. Results Ninety‐four patients were studied. CYC was prescribed in 65% and MP in 71% of the cohort. Only two patients received RTX and 15 patients received plasma exchanges (PEX). Median follow up was 31.9 (IQR: 13.7, 53.6) months. CMV infection occurred in 13 patients (13.8%) at 1.3 (0.6, 3.0) months from biopsy. Patients with CMV infection had higher serum creatinine [404 (272, 619) vs. 159 (93, 317) μmol/L, P < 0.001] and greater proteinuria [UPCR 7.5, (4.8, 11.8) vs. 4.2 (2.3, 8.4) g/g, P = 0.02] than those who did not have CMV infection. Also, more patients received CYC (92% vs. 60%, P = 0.03), RTX (15% vs. 0, P = 0.02) and PEX (38% vs. 12%, P = 0.01) than those who did not have CMV infection. Two patients had CMV‐related deaths. Conclusion Cytomegalovirus infection is common in GN patients receiving potent IS. Surveillance and possibly anti‐viral prophylaxis should be considered for high‐risk patients. Summary at a Glance CMV infection is common in patients with glomerular disease receiving immunosuppressants. Close observation or anti‐viral prophylaxis should be considered for high‐risk patients.