Abstract
Puumala orthohantavirus causes hemorrhagic fever with renal syndrome (HFRS) characterized by acute kidney injury (AKI), an abrupt decrease in renal function. Creatinine is routinely used to detect and quantify AKI; however, early AKI may not be reflected in increased creatinine levels. Therefore, kidney injury markers that can predict AKI are needed. The potential of the kidney injury markers urea, cystatin C, α1-microglobulin (A1M) and neutrophil gelatinase-associated lipocalin (NGAL) to detect early AKI during HFRS was studied by quantifying the levels of these markers in consecutively obtained plasma (P) and urine samples (U) for 44 HFRS patients. P-cystatin C and U-A1M levels were significantly increased during early HFRS compared to follow-up. In a receiver operating characteristic (ROC) curve analysis, P-cystatin C, U-A1M and P-urea predicted severe AKI with area under the curve 0.72, 0.73 and 0.71, respectively, whereas the traditional kidney injury biomarkers creatinine and U-albumin did not predict AKI. Nearly half of the HFRS patients (41%) fulfilled the criteria for shrunken pore syndrome, which was associated with the level of inflammation as measured by P-CRP. P-cystatin C and U-A1M are more sensitive and earlier markers compared to creatinine in predicting kidney injury during HFRS.
Highlights
Orthohantaviruses can cause the viral hemorrhagic fever diseases: hemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome [1,2]
acute kidney injury (AKI) is a common feature during HFRS [2], and in our study, we show that P-cystatin C, U-A1M and
EGFRcystatin C decreased significantly compared to eGFRcreatinine during early HFRS
Summary
Orthohantaviruses ( termed hantaviruses) can cause the viral hemorrhagic fever diseases: hemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome [1,2]. These diseases are characterized by fever, inflammation, capillary leakage, acute kidney injury (AKI) and lung damage. Studies have shown that these diseases may be more similar than previously assumed, in that HFRS patients have respiratory symptoms and lung damage [3,4]. AKI is a common complication during HFRS that can range from being asymptomatic to anuria [2,7].
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