Department of Medical Microbiology, Hacettepe University; Faculty of Medicine, Ankara, Turkey.
Division of Nephrology, Department of Internal Medicine, Hacettepe University; Faculty of Medicine, Ankara, Turkey.
J Med Virol. 2015 Oct;87(10):1625-32. doi: 10.1002/jmv.24226. Epub 2015 May 12.
An increased incidence of chronic kidney disease (CKD) after West Nile Virus (WNV) infections has been suggested but the association of WNV infections with renal damage remain inconclusive. This study was undertaken to characterize WNV infections in individuals with acute kidney injury (AKI) and CKD, and to evaluate hemodialysis as a probable transmission route. A total of 463 plasma and urine samples were collected from 45 AKI and 77 CKD patients. Nested and real-time polymerase chain reaction (PCR) assays were employed for viral RNA detection. Specific immunoglobulins were investigated via immunofluorescence and plaque reduction neutralization assays. Consecutive pre and post-dialysis samples were evaluated in CKD cases. WNV RNA and specific immunoglobulins were detected in 7 (5.7%) and 5 (4.1%) individuals, respectively. The AKI patients with WNV RNA in blood and urine had underlying diseases requiring immunosuppressive therapy and demonstrated moderate to high viral loads. No clinical symptom related to WNV infection were observed in CKD cases with detectable viral nucleic acids. All WNV sequences were characterized as lineage 1 clade 1a and several amino acid substitutions with unknown impact were noted. Detailed epidemiologic investigation of WNV RNA positive CKD cases revealed probable vector-borne virus exposure, without the evidence for transmission via hemodialysis.
有研究表明，西尼罗河病毒（WNV）感染后慢性肾病（CKD）的发病率增加，但 WNV 感染与肾脏损害之间的关联仍不确定。本研究旨在描述急性肾损伤（AKI）和 CKD 患者中的 WNV 感染情况，并评估血液透析是否可能成为一种传播途径。共采集了 45 例 AKI 和 77 例 CKD 患者的 463 份血浆和尿液样本。采用巢式和实时聚合酶链反应（PCR）检测病毒 RNA。通过免疫荧光和蚀斑减少中和试验检测特异性免疫球蛋白。对 CKD 患者进行连续的透析前和透析后样本评估。在 7（5.7%）和 5（4.1%）个体中分别检测到 WNV RNA 和特异性免疫球蛋白。血液和尿液中存在 WNV RNA 的 AKI 患者存在需要免疫抑制治疗的基础疾病，并且表现出中等到高水平的病毒载量。在可检测到病毒核酸的 CKD 病例中，未观察到与 WNV 感染相关的临床症状。所有 WNV 序列均被表征为 1 谱系 1 分支 1a，并且注意到了几个具有未知影响的氨基酸取代。对 WNV RNA 阳性 CKD 病例的详细流行病学调查显示，可能存在经媒介传播的病毒暴露，而没有证据表明通过血液透析传播。
