Prevalence of Chronic Kidney Disease and Progression of Disease Over Time among Patients Enrolled in the Houston West Nile Virus Cohort

被引:59
作者
Nolan, Melissa S. [1 ]
Podoll, Amber S. [2 ]
Hause, Anne M. [3 ]
Akers, Katherine M. [2 ]
Finkel, Kevin W. [2 ]
Murray, Kristy O. [1 ]
机构
[1] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA
[2] Univ Texas Hlth Sci Ctr Houston, Sch Med, Dept Internal Med, Houston, TX USA
[3] Univ Texas Hlth Sci Ctr Houston, Sch Publ Hlth, Dept Epidemiol, Houston, TX USA
来源
PLOS ONE | 2012年 / 7卷 / 07期
关键词
GELATINASE-ASSOCIATED LIPOCALIN; GLOMERULAR-FILTRATION-RATE; INFECTION; URINE; PERSISTENCE; BIOMARKER; EQUATION; INJURY; NGAL;
D O I
10.1371/journal.pone.0040374
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Introduction: In experimental models of West Nile virus (WNV) infection, animals develop chronic kidney infection with histopathological changes in the kidney up to 8-months post-infection. However, the long term pathologic effects of acute infection in humans are largely unknown. The purpose of this study was to assess renal outcomes following WNV infection, specifically the development of chronic kidney disease (CKD). Methods: In a cohort of 139 study participants with a previous diagnosis of WNV infection, we investigated the prevalence of CKD using the Kidney Disease Outcomes Quality Initiative (KDOQI) criteria based on the Modification of Diet in Renal Disease (MDRD) formula and urinary abnormalities, and assessed various risk factors and biomarkers. Results: Study participants were primarily male (60%) and non-Hispanic white (86%) with a mean age of 57 years. Most (83%) were four to nine years post-infection at the time of this study. Based on the KDOQI definition, 40% of participants had evidence of CKD, with 10% having Stage III or greater and 30% having Stage I-II. By urinary dipstick testing, 26% of patients had proteinuria and 23% had hematuria. Plasma NGAL levels were elevated in 14% of participants while MCP-1 levels were increased in 12%. Over 1.5 years, the average change in eGFR was -3.71 mL/min/1.73 m(2). Only a history of Neuroinvasive WNV disease was independently associated with CKD following multivariate analysis. Discussion: We found a high prevalence of CKD after long term follow-up in a cohort of participants previously infected with WNV. The majority of those with CKD are in Stage I-II indicating early stages of renal disease. Traditional risk factors were not associated with the presence of CKD in this population. Therefore, clinicians should regularly evaluate all patients with a history of WNV for evidence of CKD.
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