title: Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease.
abstract: OBJECTIVE
  To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients.
  
  
  METHODS
  Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included.
  
  
  RESULTS
  Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8, 57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3 ± 1.3 kg/m(2)) and hypoalbuminemia (25 ± 7.0 g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis.
  
  
  CONCLUSIONS
  CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms.
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan.
authors.forename: Yao-Ming
authors.initials: YM
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yuan-Pin
authors.initials: YP
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan.
authors.forename: Chien-Fang
authors.initials: CF
authors.lastname: Huang
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chiung-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Junne-Ming
authors.initials: JM
authors.lastname: Sung
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Internal Medicine, PingTung Christian Hospital, PingTung, Taiwan.
authors.forename: Yi-Hui
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Hsiao-Ju
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000368:Aged; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D041981:Gastrointestinal Tract / Q000473:pathology; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D062486:Public Health Surveillance; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000276:immunology; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
keywords: Chronic kidney disease; Cytomegalovirus; Gastrointestinal tract disease