tetano
Editor, Senior Moderator
Clin Kidney J
. 2020 Jun 8;13(3):362-370.
doi: 10.1093/ckj/sfaa109. eCollection 2020 Jun.
Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
Rapha?l Kormann[SUP] 1 [/SUP], Audrey Jacquot[SUP] 2 [/SUP], Asma Alla[SUP] 1 [/SUP], Alice Corbel[SUP] 1 [/SUP], Matthieu Koszutski[SUP] 2 [/SUP], Paul Voirin[SUP] 1 3 [/SUP], Matthieu Garcia Parrilla[SUP] 4 [/SUP], Sybille Bevilacqua[SUP] 3 [/SUP], Evelyne Schvoerer[SUP] 5 [/SUP], Jean-Louis Gueant[SUP] 6 [/SUP], Far?s Namour[SUP] 4 6 [/SUP], Bruno Levy[SUP] 2 7 [/SUP], Luc Frimat[SUP] 1 8 [/SUP], Abderrahim Oussalah[SUP] 4 6 [/SUP]
Affiliations
Abstract
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.
Keywords: COVID-19; Fanconi syndrome; SARS-CoV-2; acute kidney injury; acute proximal tubule injury; hypophosphataemia.
. 2020 Jun 8;13(3):362-370.
doi: 10.1093/ckj/sfaa109. eCollection 2020 Jun.
Coronavirus disease 2019: acute Fanconi syndrome precedes acute kidney injury
Rapha?l Kormann[SUP] 1 [/SUP], Audrey Jacquot[SUP] 2 [/SUP], Asma Alla[SUP] 1 [/SUP], Alice Corbel[SUP] 1 [/SUP], Matthieu Koszutski[SUP] 2 [/SUP], Paul Voirin[SUP] 1 3 [/SUP], Matthieu Garcia Parrilla[SUP] 4 [/SUP], Sybille Bevilacqua[SUP] 3 [/SUP], Evelyne Schvoerer[SUP] 5 [/SUP], Jean-Louis Gueant[SUP] 6 [/SUP], Far?s Namour[SUP] 4 6 [/SUP], Bruno Levy[SUP] 2 7 [/SUP], Luc Frimat[SUP] 1 8 [/SUP], Abderrahim Oussalah[SUP] 4 6 [/SUP]
Affiliations
- PMID: 32695327
- PMCID: PMC7314200
- DOI: 10.1093/ckj/sfaa109
Abstract
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.
Keywords: COVID-19; Fanconi syndrome; SARS-CoV-2; acute kidney injury; acute proximal tubule injury; hypophosphataemia.