Prevalence of Chronic Kidney Disease and Progression of Disease Over Time among Patients Enrolled in the Houston West Nile Virus Cohort
Prevalence of Chronic Kidney Disease and Progression of Disease Over Time among Patients Enrolled in the Houston West Nile Virus Cohort
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DOI：
10.1371/journal.pone.0040374
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发表时间：
2012-07-06
期刊：
影响因子：
3.7
通讯作者：
Murray, Kristy O.
中科院分区：
文献类型：
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作者：
Nolan, Melissa S.;Podoll, Amber S.;Murray, Kristy O.
在西尼罗病毒（WNV）感染的实验模型中，动物在感染后8个月出现肾脏组织病理改变的慢性肾脏感染。然而，人类急性感染的长期病理效应在很大程度上是未知的。本研究的目的是评估西尼罗河病毒感染后的肾脏预后，特别是慢性肾脏疾病（CKD）的发展。方法：在139名既往诊断为西尼罗病毒感染的研究参与者中，我们使用基于肾脏疾病饮食调整（MDRD）配方和泌尿异常的肾脏疾病结局质量倡议（KDOQI）标准调查CKD的患病率，并评估各种危险因素和生物标志物。结果：研究参与者主要为男性（60%）和非西班牙裔白人（86%），平均年龄为57岁。在这项研究中，大多数（83%）是在感染后4至9年。根据KDOQI的定义，40%的参与者有CKD的证据，其中10%为III期或以上，30%为I-II期。通过尿试纸测试，26%的患者有蛋白尿，23%的患者有血尿。14%的受试者血浆NGAL水平升高，12%的受试者血浆MCP-1水平升高。在1.5年中，eGFR的平均变化为-3.71 mL/min/1.73 m(2)。多变量分析显示，只有神经侵袭性西尼罗河病毒病史与CKD独立相关。讨论：我们发现，在一组先前感染西尼罗河病毒的参与者中，长期随访后CKD的患病率很高。大多数CKD患者处于I-II期，即肾脏疾病的早期阶段。传统的危险因素与该人群中CKD的存在无关。因此，临床医生应定期评估所有有西尼罗河病毒病史的患者是否患有CKD。
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.