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Renal Function Impairment in Children With Congenital Cytomegalovirus Infection: A Cross-sectional Study
María Ríos-Barnés1, Eneritz Velasco-Arnaiz1, Clàudia Fortuny1,2,3,4
1From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
Insights
Mild, asymptomatic tubular proteinuria is common in young children with congenital cytomegalovirus (cCMV) infection. This kidney dysfunction, affecting about 40%, is not linked to disease severity or treatment.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Virology
Background:
- Congenital cytomegalovirus (cCMV) infection can lead to renal dysfunction in infants and toddlers.
- Urinalysis is a key tool for assessing kidney health in this population.
- Understanding the prevalence and type of renal dysfunction is crucial for patient management.
Purpose of the Study:
- To determine the prevalence and severity of glomerular and tubular renal dysfunction in infants and toddlers with cCMV infection using urinalysis.
- To investigate the association between renal dysfunction and cCMV disease, viruria, and antiviral treatment.
Main Methods:
- A cross-sectional study utilizing the Spanish Registry of Congenital Cytomegalovirus Infection.
- Urine samples from 77 patients under 5 years old were analyzed for protein/creatinine and albumin/creatinine ratios, beta-2-microglobulin, and hematuria.
- Tubular vs. glomerular proteinuria was defined using a urinary albumin/protein ratio cutoff of 0.4.
Main Results:
- 37.5% and 41.9% of patients showed elevated urinary protein/creatinine and albumin/creatinine ratios, respectively.
- Tubular proteinuria (88.3%) was significantly more prevalent than glomerular proteinuria (11.6%).
- Female gender was identified as a risk factor for tubular proteinuria; cCMV disease, viruria, or antiviral use were not associated with urinalysis findings.
Conclusions:
- Mild, asymptomatic tubular proteinuria affects approximately 40% of infants and toddlers with cCMV infection within the first five years of life.
- The observed renal dysfunction is predominantly tubular and mild, with no association with cCMV disease severity or treatment.
Background:
We aimed to determine the prevalence and severity of glomerular and tubular renal dysfunction by means of urinalysis in infants and toddlers with congenital cytomegalovirus infection (cCMV) and their association with cCMV disease, viruria and antiviral treatment.
Methods:
This cross-sectional study was done using the Spanish Registry of Congenital Cytomegalovirus Infection. First-morning urine samples were collected from January 2016 to December 2018 from patients <5 years old enrolled in Spanish Registry of Congenital Cytomegalovirus Infection. Samples were excluded in case of fever or other signs or symptoms consistent with acute infection, bacteriuria or bacterial growth in urine culture. Urinary protein/creatinine and albumin/creatinine ratios, urinary beta-2-microglobulin levels, hematuria and CMV viruria were determined. A 0.4 cutoff in the urinary albumin/protein ratio was used to define tubular (<0.4) or glomerular (>0.4) proteinuria. Signs and symptoms of cCMV at birth, the use of antivirals and cCMV-associated sequelae at last available follow-up were obtained from Spanish Registry of Congenital Cytomegalovirus Infection.
Results:
Seventy-seven patients (37 females, 48.1%; median [interquartile range] age: 14.0 [4.4-36.2] months) were included. Symptom-free elevated urinary protein/creatinine and albumin/creatinine ratios were observed in 37.5% and 41.9% of patients, respectively, with tubular proteinuria prevailing (88.3%) over glomerular proteinuria (11.6%). Proteinuria in the nephrotic range was not observed in any patients. In multivariate analysis, female gender was the only risk factor for tubular proteinuria (adjusted odds ratio = 3.339, 95% confidence interval: 1.086-10.268; P = 0.035). cCMV disease at birth, long-term sequelae, viruria or the use of antivirals were not associated with urinalysis findings.
Conclusions:
Mild nonsymptomatic tubular proteinuria affects approximately 40% of infants and toddlers with mostly symptomatic cCMV in the first 5 years of life.
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