West Nile May Lead to Kidney Disease

By Kristina Fiore, Staff Writer, MedPage Today

Published: April 05, 2013
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania

 

ORLANDO — When patients who’ve had a West Nile virus infection develop chronic kidney disease (CKD), it’s unlikely that traditional risk factors play a role, a case-control study suggested.

For instance, hypertension is a typical risk factor for kidney disease, yet controls who’d never had the virus were more likely to have hypertension than those who had had West Nile virus — 64% controls versus 45% of West Nile cases (OR 0.45, 95% CI 0.23 to 0.91,P=0.026), Melissa Nolan, MPH, of Baylor College of Medicine in Houston, and colleagues reported during a poster session at the National Kidney Foundation meeting here.

They did find that case patients with stage 3 to 5 CKD had significantly greater odds of having proteinuria than controls (OR 2.79, P=0.05).

“Proteinuria is a distinguishing biomarker between those with and without West Nile-related kidney disease,” Nolan and colleagues wrote.

Bill Schaffner, MD, an infectious disease specialist at Vanderbilt University in Nashville, Tenn., toldMedPage Today that Nolan’s group has had some of the “best long-term follow-up of West Nile survivors,” and that the virus’s link to delayed kidney disease “seems to be a valid phenomenon.”

West Nile May Lead to Kidney Disease - Health Care News

The virus has been shown to cause persistent infection in animals, with the kidney being a preferred site of replication.

Nolan’s group had previously reported a case series of 139 patients who’d had West Nile virus; 40% of the survivors had chronic kidney disease — a much higher prevalence than expected.

Furthermore, a history of neuroinvasive disease had been the only significant predictor of disease in this population: “They don’t have diabetes, they don’t have hypertension,” Nolan told MedPage Today.

To advance the strength of their evidence, she and her colleagues conducted a matched case-control study with those 139 West Nile survivors, who had a mean age of 65.

Controls who’d never had West Nile were recruited from a University of Texas physician’s renal clinic from May 2012 to March 2013, and matched 2-to-1 to cases based on age, race/ethnicity, gender, and CKD stage.

In a multivariate regression analysis, Nolan and colleagues found that although hypertension didn’t appear to be behind the development of kidney disease in the cases, tobacco use did appear to be a risk factor for cases compared with controls, they reported.

“Smoking cessation could help minimize any further renal deterioration in this population,” they wrote.

Although she cautioned against speculation about possible causes for the eventual decline in renal function in patients previously infected with West Nile virus, Nolan suggested the virus “could be causing chronic persistent infection in the kidney tubules, causing inflammation.”

Schaffner pointed out that patients involved in the study were of lower socioeconomic status, which may also play some role in pathogenesis.

He added that delayed kidney disease isn’t common in any other viral infections and is “quite distinctive” to West Nile.

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