Imported haemorrhagic fever with renal syndrome caused by Dobrava-Belgrade hantavirus in France.

Acute kidney injury (AKI) caused by hantavirus infections is rare but should be suspected in any patient presenting with flu-like symptoms, signs of haemolytic-uraemic syndrome or presence of anti-glomerular basement membrane (anti-GBM) antibodies. We report the first case of Dobrava-Belgrade virus in France imported from southeastern Europe. The characteristic macroscopic appearance of the fresh renal biopsy specimen, displaying a haemorrhagic appearance of the medulla, suggested hantavirus infection. AKI caused by hantavirus infections remains a diagnostic challenge, especially outside endemic areas.

A new expression of immune checkpoint inhibitors' renal toxicity: when distal tubular acidosis precedes creatinine elevation.

The main manifestation of acute interstitial nephritis (AIN) due to immune checkpoint inhibitors is acute kidney injury. We report here a biopsy-proven AIN revealed by tubular acidosis. This case highlights that immune checkpoint inhibitor prescribers must be aware of electrolytic disorders since tubular dysfunction can precede serum creatinine increase and reveal renal toxicity.

Are triplicate urine samples necessary to assess albuminuria?

BACKGROUND/AIMS: Urinary albumin excretion is subject to intra-individual variability. Thus, for research purposes, it is recommended to test three urine samples collected over a short period of time. The objective of our analysis was to check the usefulness of triplicate samples to determine the albuminuric status of diabetic patients. METHODS: We present the results of the non-planned retrospective analysis of 246 triplicate morning urine samples obtained from 95 type 2 diabetics included in three multinational, randomized, double-blind studies. Albuminuria was determined by immunoturbidimetry on fresh samples in the same central laboratory. Microalbuminuria was defined by a urine albumin to creatinine ratio (UACR) between 2.5 and 25 mg/mmol in males and between 3.5 and 35 mg/mmol in females. Concordance was obtained when the second and/or third sample (UACR2 and UACR3) confirmed the albuminuric status obtained from the first sample (UACR1). RESULTS: Considering the first samples, 9% were within the normal range, 35% showed microalbuminuria and 56% showed macroalbuminuria. The overall concordance rate was 95%. The log of UACR was highly correlated between samples. Bland-Altman plots expressed in percent variations between two samples confirmed that the mean variation was low (around 8%) but revealed the scattering of values, 95% being between -60 and +77% of variation between samples. CONCLUSIONS: There is no benefit in repeating morning UACR determination in diabetic patients to accurately categorize a subject as having normo-, micro- or macroalbuminuria. However, in order to accurately quantify albuminuria, repeated determinations are required.

The best way to detect elevated albuminuria.

BACKGROUND: It has been reported that first morning specimens are more reliable than random spot specimens to assess 24-hour urinary albumin excretion rate (UAER), especially if albuminuria is expressed as albuminuria to creatininuria ratio. We aimed to investigate the influence of (a) posture and activity and (b) the units to best estimate 24-hour albuminuria. METHODS: In this retrospective study, 24-hour UAER was compared to 60 min 'supine' and 90 min 'activity' albuminuria in 124 patients tested for resistant hypertension. The ability to adjust urinary albumin concentration (UAC) to creatininuria (ACR) or to collection duration (tAER) values in order to increase the reliability of albuminuria values was also analyzed. RESULTS: Compared to 24-hour UAER, UAC (mg/l), tAER (µg/min) and ACR (mg/mmol) during the supine period had a similar concordance rate in normo-, micro- and macroalbuminuric patients. The UAC in the supine period was well related to 24-hour UAER. However, UAC almost doubled during activity. Adjustment to creatininuria improved the correlation between albuminuria during both periods and 24-hour UAER, but mainly during the activity period. CONCLUSIONS: Our results confirm that UAC is dependent on physical activity. Correction of UAC by creatininuria (ACR) provides a satisfactory estimation of 24-hour UAER. Thus, for practical reasons, it is advisable to use ACR, where no differences appear to exist, whether a supine urine sample or an activity urine sample is obtained.