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ScienceDirect www.sciencedirect.com Médecine et maladies infectieuses xxx (2015) xxx–xxx

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Renal dysfunction in adults during measles夽 Atteinte rénale chez l’adulte au cours de la rougeole A. Chassort a,∗ , J. Coutherut b , A. Moreau-Klein c , C. Gras-Le Guen d , D. Trewick e , F. Raffi a , C. Biron a,b a

Service de maladies infectieuses et tropicales, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France b Centre de vaccinations polyvalentes, CHU de Nantes, 5, rue du Pr-Yves-Boquien, 44093 Nantes cedex 1, France c Laboratoire de virologie, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France d Service de pédiatrie, CHU de Nantes, 7, quai Moncousu, 44093 Nantes cedex 1, France e Pôle des urgences, CHU de Nantes, 9, quai Moncousu, 44093 Nantes cedex 1, France Received 20 September 2014; received in revised form 24 February 2015; accepted 13 March 2015

Abstract Background. – Many cases of measles in adults were notified during the epidemic in France in 2008. Studying these cases can lead to a better understanding of their potential complications, little data having been reported on renal dysfunction during measles. Methods. – A retrospective study of biologically confirmed measles cases in patients hospitalized for more than 24 hours was carried out in the Nantes Teaching Hospital, between January and December 2011. The renal function was assessed using the modification of diet in renal disease (MDRD) equation. Results. – Thirty-eight patients were included, 17 (45%) presented with a clearance below 90 mL/min. One patient presented with acute renal failure, with a clearance at 37 mL/min, and proteinuria at 2.8 g/L. His renal function was restored on day 2. Conclusion. – Acute renal failure can occur during measles in adults. Serum creatinine should be systematically assessed during the initial medical evaluation. © 2015 Elsevier Masson SAS. All rights reserved. Keywords: Measles; Renal dysfunction

Résumé Objectifs. – De nombreux cas de rougeole adultes ont été recensés au cours de l’épidémie survenue en France entre 2008 et 2011. Leur étude permet une meilleure connaissance des complications potentielles, peu d’éléments ayant été rapportés concernant l’atteinte rénale. Patients et méthodes. – Étude rétrospective des cas de rougeole confirmés biologiquement et hospitalisés plus de 24 heures au CHU de Nantes entre janvier et décembre 2011. La fonction rénale était estimée à l’aide du modification of diet in renal disease (MDRD). Résultats. – Trente-huit adultes ont été inclus dont 17 (45 %) ont présenté une clairance calculée inférieure à 90 mL/min. L’un d’eux a présenté une insuffisance rénale aiguë avec clairance à 37 mL/min et une protéinurie à 2,8 g/L. Sa fonction rénale s’est normalisée à j2. Conclusion. – Une insuffisance rénale aiguë peut survenir lors d’une rougeole chez l’adulte. Le dosage systématique de la créatininémie lors du bilan initial nous semble être pertinent. © 2015 Elsevier Masson SAS. Tous droits réservés. Mots clés : Atteinte rénale ; Rougeole 夽

Study presented during the « Journées nationales d’infectiologie » in Bordeaux, France (June 2014). Corresponding author. E-mail addresses: [email protected] (A. Chassort), [email protected] (J. Coutherut), [email protected] (A. Moreau-Klein), [email protected] (C. Gras-Le Guen), [email protected] (D. Trewick), [email protected] (F. Raffi), [email protected] (C. Biron). ∗

http://dx.doi.org/10.1016/j.medmal.2015.03.008 0399-077X/© 2015 Elsevier Masson SAS. All rights reserved.

Please cite this article in press as: Chassort A, et al. Renal dysfunction in adults during measles. Med Mal Infect (2015), http://dx.doi.org/10.1016/j.medmal.2015.03.008

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A. Chassort et al. / Médecine et maladies infectieuses xxx (2015) xxx–xxx

1. Introduction A significant outbreak of measles occurred in France between 2008 and 2011 characterized by an increase in the number of patients 20 years of age or more, in the rate of hospitalized patients, and in the number of complications [1,2]. The authors of a multicenter retrospective study conducted in 2011 reported the characteristics of adult measles cases having occurred during this epidemic [3]. The Nantes University Hospital participated in this study, the analysis of Nantes cases was the topic of a substudy [4]. The pulmonary, neurologic, and hepatic complications of measles have been described extensively because of their severity and frequency [5–10], but renal dysfunction during measles in adults has rarely been studied. Analyzing renal dysfunction observed in our Nantes study seemed relevant to document its epidemiology and diagnosis during measles in adults. 2. Methods The study was a retrospective analysis of laboratory confirmed cases of measles (identified by the Nantes University Hospital virology laboratory) in patients hospitalized for more than 24 hours at the Nantes University Hospital, between January 1 and December 31, 2011. A patient 15 years and three months of age or more was considered as an adult case. The data was extracted from the computerized patient record (CNIL 1620501v0) and collected with a form used in the multicenter national study [3]. Creatinine clearance was calculated with the modification of diet in renal disease (MDRD) equation. Renal failure was considered when the clearance was