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Cytomegalovirus infection in patients with lupus nephritis: clinical and laboratory features and therapeutic considerations

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Abstract

To better clarify the clinical features and therapeutic strategy of CMV infection in lupus nephritis patients, we retrospectively surveyed a total of 40 lupus nephritis patients, who had been hospitalized and underwent renal biopsy and diagnosed as having CMV infection during their hospitalization at our institution within the last 10 years. The percentage of CMV infections in the entire hospitalized lupus nephritis population was 5.3% (40/755). The principal clinical features of the 40 CMV-infected patients were hematological disorders (n = 25), fever (n = 21), liver dysfunction (n = 19), and respiratory symptoms (n = 12). Active SLE (SLEDAI 16 ± 5), hypertriglyceridemia (3.16 ± 2.57 mmol/L), and a history of potent immunosuppressive therapy were commonly observed in this patient group. There were no significant differences of SLEDAI (P = 0.290), proteinuria (P = 0.065), hematuria (P = 0.497), CLCR (P = 0.463), and the distribution of histopathologic classes between patients with symptomatic and asymptomatic infection. Ganciclovir was administered in 33 cases; in patients with symptomatic infection, the improvement in CMV symptoms was not observed until ganciclovir was administered, while in asymptomatic patients, no treatment benefit was observed as for survival, the duration of hospital stays, and the number of patients who progressed from asymptomatic to symptomatic infection. In conclusion, CMV infection is not rare in lupus nephritis patients. SLE activity and renal clinical and pathological features between patients with symptomatic and asymptomatic infection are of no significant difference. Although therapy consensus guideline is still lacking, we observed no treatment benefit for the asymptomatic patients.

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References

  1. Britt W. Manifestations of human cytomegalovirus infection: proposed mechanism of acute and chronic disease. Curr Top Microbiol Immunol. 2008;325:417–70.

    CAS  PubMed  Google Scholar 

  2. Boeckh M, Geballe AP. Cytomegalovirus: pathogen, paradigm, and puzzle. J Clin Investig. 2011;121:1673–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kumar A, Herbein G. Epigenetic regulation of human cytomegalovirus latency: an update. Epigenomics. 2014;6:533–46.

    Article  CAS  PubMed  Google Scholar 

  4. Mubarak M, Nasri H. ISN/RPS 2003 classification of lupus nephritis: time to take a look on the achievements and limitations of the schema. J Nephropathol. 2014;3:87–90.

    PubMed  PubMed Central  Google Scholar 

  5. Dmitrienko S, Yu A, Balshaw R, Shapiro RJ, Keown PA. The use of consensus guidelines for management of cytomegalovirus infection in renal transplantation. Kidney Int. 2007;72:1014–22.

    Article  CAS  PubMed  Google Scholar 

  6. Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34:1094–7.

    Article  PubMed  Google Scholar 

  7. Takizawa Y, Inokuma S, Tanaka Y, et al. Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. Rheumatology. 2008;47:1373–8.

    Article  CAS  PubMed  Google Scholar 

  8. Hrycek A, Kuśmierz D, Mazurek U, Wilczok T. Human cytomegalovirus in patients with systemic lupus erythematosus. Autoimmunity. 2005;38:487–91.

    Article  PubMed  Google Scholar 

  9. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhang J, Dou Y, Zhong Z, et al. Clinical characteristics and therapy exploration of active human cytomegalovirus infection in 105 lupus patients. Lupus. 2014;23:889–97.

    Article  CAS  PubMed  Google Scholar 

  11. Boeckh M, Ljungman P. How we treat cytomegalovirus in hematopoietic cell transplant recipients. Blood. 2009;113:5711–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sekigawa I, Nawata M, Seta N, Yamada M, Iida N, Hashimoto H. Cytomegalovirus infection in patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2002;20:559–64.

    CAS  PubMed  Google Scholar 

  13. Chatham WW, Kimberly RP. Treatment of lupus with corticosteroids. Lupus. 2001;10:140–7.

    Article  CAS  PubMed  Google Scholar 

  14. Boeckh M, Nichols WG. Immunosuppressive effects of beta-herpesviruses. Herpes. 2003;10:12–6.

    PubMed  Google Scholar 

  15. Ramos-Casals M, Cuadrado MJ, Alba P, et al. Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature. Medicine (Baltimore). 2008;87:311–8.

    Article  Google Scholar 

  16. Esposito S, Bosis S, Semino M, Rigante D. Infections and systemic lupus erythematosus. Eur J Clin Microbiol Infect Dis. 2014;33:1467–75.

    Article  CAS  PubMed  Google Scholar 

  17. Su BY, Su CY, Yu SF, Chen CJ. Incidental discovery of high systemic lupus erythematosus disease activity associated with CMV viral activity. Med Microbiol Immunol. 2007;196:165–70.

    Article  PubMed  Google Scholar 

  18. Sepkowitz KA. Effect of HAART on natural history of AIDS-related opportunistic disorders. Lancet. 1998;351:228–30.

    Article  CAS  PubMed  Google Scholar 

  19. Adeva M, Lorenzo D, Fontán MP, et al. Severe HTG post-renal graft: is there a relationship with infection by cytomegalovirus? Clin Nephrol. 1996;45:137–8.

    CAS  PubMed  Google Scholar 

  20. Grunfeld C, Feingold KR. Tumor necrosis factor, cytokines, and the hyperlipidemia of infection. Trends Endocrinol Metab. 1991;2:213–9.

    Article  CAS  PubMed  Google Scholar 

  21. David N, George M, Robert C, Henry F, Michael S. The Sanford guide to antimicrobial therapy. 44th ed. Sperryville: Antimicrobial Therapy; 2014. p. 160–207.

    Google Scholar 

  22. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transpl. 2009;15:1143–238.

    Article  CAS  Google Scholar 

  23. Jung GO, Kim SJ, Choi GS, et al. The effect of cytomegalovirus antigenemia titer on the efficacy of preemptive therapy for the prevention of cytomegalovirus disease after kidney transplantation. Transpl Proc. 2010;42:804–10.

    Article  CAS  Google Scholar 

  24. De Keyzer K, Van Laecke S, Peeters P, Vanholder R. Human cytomegalovirus and kidney transplantation: a clinician’s update. Am J Kidney Dis. 2011;58:118–26.

    Article  PubMed  Google Scholar 

  25. Preiksaitis JK, Brennan DC, Fishman J, Allen U. Canadian Society of Transplantation consensus workshop on cytomegalovirus management in solid organ transplantation final report. Am J Transpl. 2005;5:218–27.

    Article  Google Scholar 

  26. Heiden D, Saranchuk P. CMV retinitis in China and SE Asia: the way forward. BMC Infect Dis. 2011;11:327.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kotton CN, Kumar D, Caliendo AM. International consensus guidelines on the management of cytomegalovirus in solid organ transplantation. Transplantation. 2010;89:779–95.

    Article  PubMed  Google Scholar 

  28. Stewart MW. Optimal management of cytomegalovirus retinitis in patients with AIDS. Clin Ophthalmol. 2010;4:285–99.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kotton CN. CMV: prevention, diagnosis and therapy. Am J Transpl. 2013;13(Suppl 3):24–40.

    Article  Google Scholar 

  30. Humar A, Snydman D, AST Infectious Diseases Community of Practice. Cytomegalovirus in solid organ transplant recipients. Am J Transpl. 2009;9(Suppl 4):78–86.

    Article  Google Scholar 

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Acknowledgements

This study was funded by National Natural Science Foundation of China (No. 81170665). The authors would like to thank all those who cooperated with us in collecting the valuable clinical data. Editorial assistance with the manuscript was provided by Content Ed Net, Shanghai Ltd.

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    Authors and Affiliations

    1. Department of Nephrology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

      Lei Zhang, Jianling Tao, Yubing Wen, Xueyi Wu, Xuewang Li & Xuemei Li

    2. Department of Nephrology, Traditional Chinese Medicine of Fangshan Hospital, Fangshan District, Beijing, 102400, China

      Li Li

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    1. Lei Zhang
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    2. Jianling Tao
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    7. Xuemei Li
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    Correspondence to Xuemei Li.

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    All procedures performed in the study involving human participants were in accordance with the ethical standards of the Ethics Committee of Peking Union Medical College Hospital and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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    Lei Zhang and Jianling Tao have contributed equally to this article.

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    Zhang, L., Tao, J., Wen, Y. et al. Cytomegalovirus infection in patients with lupus nephritis: clinical and laboratory features and therapeutic considerations. Clin Exp Med 17, 467–475 (2017). https://doi.org/10.1007/s10238-017-0456-3

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    • DOI: https://doi.org/10.1007/s10238-017-0456-3

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