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Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury

BACKGROUND: Recent data have shown that severe acute respiratory syndrome coronavirus 2 can infect renal proximal tubular cells via Angiotensin Converting Enzyme 2 (ACE2) . Our objective was to determine whether Fanconi syndrome is a frequent clinical feature in coronavirus disease 2019 (COVID-19) p...

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Autores principales: Kormann, Raphaël, Jacquot, Audrey, Alla, Asma, Corbel, Alice, Koszutski, Matthieu, Voirin, Paul, Garcia Parrilla, Matthieu, Bevilacqua, Sybille, Schvoerer, Evelyne, Gueant, Jean-Louis, Namour, Farès, Levy, Bruno, Frimat, Luc, Oussalah, Abderrahim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314200/
https://www.ncbi.nlm.nih.gov/pubmed/32695327
http://dx.doi.org/10.1093/ckj/sfaa109
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author Kormann, Raphaël
Jacquot, Audrey
Alla, Asma
Corbel, Alice
Koszutski, Matthieu
Voirin, Paul
Garcia Parrilla, Matthieu
Bevilacqua, Sybille
Schvoerer, Evelyne
Gueant, Jean-Louis
Namour, Farès
Levy, Bruno
Frimat, Luc
Oussalah, Abderrahim
author_facet Kormann, Raphaël
Jacquot, Audrey
Alla, Asma
Corbel, Alice
Koszutski, Matthieu
Voirin, Paul
Garcia Parrilla, Matthieu
Bevilacqua, Sybille
Schvoerer, Evelyne
Gueant, Jean-Louis
Namour, Farès
Levy, Bruno
Frimat, Luc
Oussalah, Abderrahim
author_sort Kormann, Raphaël
collection PubMed
description BACKGROUND: Recent data have shown that severe acute respiratory syndrome coronavirus 2 can infect renal proximal tubular cells via Angiotensin Converting Enzyme 2 (ACE2) . Our objective was to determine whether Fanconi syndrome is a frequent clinical feature in coronavirus disease 2019 (COVID-19) patients. METHODS: A retrospective cohort of 42 laboratory-confirmed COVID-19 patients without history of kidney disease hospitalized in University Hospital of Nancy was investigated. Patients were admitted to the intensive care unit (ICU) (n = 28) or the Medical department (n = 14) and were screened at least once for four markers of proximal tubulopathy. RESULTS: The mean (standard deviation) follow-up was 19.7 (±12.2) days. Of the patients, 75% (30/40) showed at least two proximal tubule abnormalities (incomplete Fanconi syndrome). The main disorders were proteinuria (88%, n = 35), renal phosphate leak defined by renal phosphate threshold/glomerular filtration rate (TmPi/GFR) <0.77 (55%, n = 22), hyperuricosuria (43%, n = 17) and normoglycaemic glycosuria (30%, n = 12). At the time of the first renal evaluation, ICU patients presented more frequent (96 versus 62%, P = 0.0095) and more severe (844 ± 343 versus 350 ± 221 mg/g, P = 0.0001) proteinuria, and a trend for an increased number of proximal tubule abnormalities (P = 0.038). During follow-up, they presented a lower nadir of serum phosphate [median (interquartile range) 0.68 (0.43–0.76) versus 0.77 (0.66–1.07) mmol/L, P = 0.044] and Acute kidney Injury (AKI) during the hospitalization (P = 0.045). Fanconi syndrome preceded severe AKI KDIGO Stages 2 and 3 in 88% (7/8) of patients. Proximal tubular abnormalities (such as proteinuria, TmPi/GFR and glycosuria in five, two and two patients, respectively) were not detected anymore in recovering patients before hospital discharge. CONCLUSION: Incomplete Fanconi syndrome is highly frequent in COVID-19 patients and precedes AKI or disappears during the recovery phase.
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spelling pubmed-73142002020-06-25 Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury Kormann, Raphaël Jacquot, Audrey Alla, Asma Corbel, Alice Koszutski, Matthieu Voirin, Paul Garcia Parrilla, Matthieu Bevilacqua, Sybille Schvoerer, Evelyne Gueant, Jean-Louis Namour, Farès Levy, Bruno Frimat, Luc Oussalah, Abderrahim Clin Kidney J Original Articles BACKGROUND: Recent data have shown that severe acute respiratory syndrome coronavirus 2 can infect renal proximal tubular cells via Angiotensin Converting Enzyme 2 (ACE2) . Our objective was to determine whether Fanconi syndrome is a frequent clinical feature in coronavirus disease 2019 (COVID-19) patients. METHODS: A retrospective cohort of 42 laboratory-confirmed COVID-19 patients without history of kidney disease hospitalized in University Hospital of Nancy was investigated. Patients were admitted to the intensive care unit (ICU) (n = 28) or the Medical department (n = 14) and were screened at least once for four markers of proximal tubulopathy. RESULTS: The mean (standard deviation) follow-up was 19.7 (±12.2) days. Of the patients, 75% (30/40) showed at least two proximal tubule abnormalities (incomplete Fanconi syndrome). The main disorders were proteinuria (88%, n = 35), renal phosphate leak defined by renal phosphate threshold/glomerular filtration rate (TmPi/GFR) <0.77 (55%, n = 22), hyperuricosuria (43%, n = 17) and normoglycaemic glycosuria (30%, n = 12). At the time of the first renal evaluation, ICU patients presented more frequent (96 versus 62%, P = 0.0095) and more severe (844 ± 343 versus 350 ± 221 mg/g, P = 0.0001) proteinuria, and a trend for an increased number of proximal tubule abnormalities (P = 0.038). During follow-up, they presented a lower nadir of serum phosphate [median (interquartile range) 0.68 (0.43–0.76) versus 0.77 (0.66–1.07) mmol/L, P = 0.044] and Acute kidney Injury (AKI) during the hospitalization (P = 0.045). Fanconi syndrome preceded severe AKI KDIGO Stages 2 and 3 in 88% (7/8) of patients. Proximal tubular abnormalities (such as proteinuria, TmPi/GFR and glycosuria in five, two and two patients, respectively) were not detected anymore in recovering patients before hospital discharge. CONCLUSION: Incomplete Fanconi syndrome is highly frequent in COVID-19 patients and precedes AKI or disappears during the recovery phase. Oxford University Press 2020-06-08 /pmc/articles/PMC7314200/ /pubmed/32695327 http://dx.doi.org/10.1093/ckj/sfaa109 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Kormann, Raphaël
Jacquot, Audrey
Alla, Asma
Corbel, Alice
Koszutski, Matthieu
Voirin, Paul
Garcia Parrilla, Matthieu
Bevilacqua, Sybille
Schvoerer, Evelyne
Gueant, Jean-Louis
Namour, Farès
Levy, Bruno
Frimat, Luc
Oussalah, Abderrahim
Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
title Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
title_full Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
title_fullStr Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
title_full_unstemmed Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
title_short Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
title_sort coronavirus disease 2019: acute fanconi syndrome precedes acute kidney injury
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314200/
https://www.ncbi.nlm.nih.gov/pubmed/32695327
http://dx.doi.org/10.1093/ckj/sfaa109
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