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

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.