An oral abstract presented at the ASN 2011 session talked about an interesting new entity that we should now consider in our diagnosis - West Nile associated Nephropathy presented by Dr. Podoll.
West nile is a zoonotic infection that infects horses and humans and bird as the vector. WN is an arbovirus, sRNA and there are 3.8 million infected cases in the USA.
There are many neurological sequelae that we have read about that can come from WN. Apparently, many also develop chronic neurological damage. Bird autopsies have shown that the virus can also live in the kidney and usually in the tubules. The Hampster model has shown that it can have peri tubular damage.
Of 208 patients with chronic WN neuropathy, 70 were found to have been shedding WN RNA in their urine. Most of them were male and 47% had proteinuria. 28% had GFR < 60 and the urine sediment showed predominant monocytes, epithelial cells. 6 biopsies found chronic tubular interstitial disease with predominantly monocytes. Glomeruli were normal. EM showed virion particles within the tubules. Immuno was negative in all cases. There was chronic interstitial fibrosis and tubular atrophy.
This is interesting - chronic TI disease from West Nile Nephropathy- keep this in your differential in the endemic areas of USA and the world
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