Renal Involvement in Congenital Cytomegalovirus Infection: A Systematic Review.

Antoni Noguera-Julian,Ana Alarcón,Clàudia Fortuny,María Ríos-Barnés

doi:10.3390/microorganisms9061304

Abstract

Background: Congenital cytomegalovirus (cCMV) infection is the most frequent mother-to-child transmitted infection worldwide and a prevalent cause of neonatal disease and long-term morbidity. The kidney is a target organ for CMV, which replicates in renal tubules and is excreted in large quantities in urine for years in children with cCMV infection. Nonetheless, kidney disease has rarely been reported in cCMV-infected patients. Objective: We aimed to describe the available data on renal involvement in patients with cCMV infection at the pathologic, functional, anatomical, and/or clinical levels. Methods: A systematic search was performed in the MEDLINE/PubMed, SCOPUS, and Cochrane databases. Studies describing any renal involvement in fetuses or neonates aged ≤3 weeks at diagnosis of microbiologically confirmed cCMV infection were eligible. Results: Twenty-four articles were included, with a very low level of evidence. Pathologic findings in autopsy studies universally described CMV typical inclusion bodies in tubular cells. No functional studies were identified. cCMV infection was not associated with an increased risk of kidney malformations. Congenital nephrotic syndrome was the most common clinical condition associated with cCMV, but a causal relationship cannot be established. Conclusions: Typical pathological features of cCMV infection are very common in renal tissue, but they do not seem to entail significant consequences at the anatomical or clinical levels.

Highlights

Human cytomegalovirus (CMV) is a member of the β Herpesvirinae subfamily
We aimed to describe the available data on renal involvement in patients with Congenital cytomegalovirus (cCMV) infection at the pathologic, functional, anatomical, and/or clinical levels
Children with cCMV infections exhibit the highest prevalence of urine CMV shedding and duration of shedding when compared with postnatal-infected healthy children or adults diagnosed with sexually transmitted diseases [2], and urine molecular tests have become the gold standard for the diagnosis of cCMV infections [22]

Summary

Introduction

Human cytomegalovirus (CMV) is a member of the β Herpesvirinae subfamily. CMV is usually inoculated in the healthy host through exposure of the upper respiratory or genital tract to contaminated fluids such as urine, saliva, semen, cervical secretions, and human milk. CMV viremia leads to dissemination to a wide range of tissues in various organs, where the characteristic “owl’s eye” intranuclear inclusions can be seen [1]. Among others, the former include the intestinal mucosa, the salivary glands, the lungs, and the kidneys. The kidney is a target organ for CMV, which replicates in renal tubules and is excreted in large quantities in urine for years in children with cCMV infection. Objective: We aimed to describe the available data on renal involvement in patients with cCMV infection at the pathologic, functional, anatomical, and/or clinical levels. No functional studies were identified. cCMV infection was not associated with an increased risk of kidney malformations

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