Prevalence of chronic kidney disease and progression of disease over time among patients enrolled in the Houston West Nile virus cohort.
BACKGROUND
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.


CONCLUSIONS
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.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America.
Melissa S
MS
Nolan
Amber S
AS
Podoll
Anne M
AM
Hause
Katherine M
KM
Akers
Kevin W
KW
Finkel
Kristy O
KO
Murray
D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D018932:Chemokine CCL2 / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000821:virology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000652:urine / Q000821:virology*; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014901:West Nile Fever / Q000150:complications* / Q000821:virology; D014902:West Nile virus
D000209:Acute-Phase Proteins; C111835:CCL2 protein, human; D018932:Chemokine CCL2; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins