Flash-Like Albuminuria in Acute Kidney Injury Caused by Puumala Hantavirus Infection.

Paula Mantula,Jukka Mustonen,Satu Mäkelä,Onni Niemelä,Ilkka Pörsti,Tuula Outinen,Johanna Tietäväinen,Antti Vaheri,Jan Clement

doi:10.3390/pathogens9080615

Abstract

Transient proteinuria and acute kidney injury (AKI) are characteristics of Puumala virus (PUUV) infection. Albuminuria peaks around the fifth day and associates with AKI severity. To evaluate albuminuria disappearance rate, we quantified albumin excretion at different time points after the fever onset. The study included 141 consecutive patients hospitalized due to acute PUUV infection in Tampere University Hospital, Finland. Timed overnight albumin excretion (cU-Alb) was measured during the acute phase in 133 patients, once or twice during the convalescent phase within three months in 94 patients, and at six months in 36 patients. During hospitalization, 30% of the patients had moderately increased albuminuria (cU-Alb 20–200 μg/min), while 57% presented with severely increased albuminuria (cU-Alb >200 μg/min). Median cU-Alb was 311 μg/min (range 2.2–6460) ≤7 days after fever onset, 235 μg/min (range 6.8–5479) at 8–13 days and 2.8 μg/min (range 0.5–18.2) at 14–20 days. After that, only one of the measurements showed albuminuria (35.4 μg/min at day 44). At six months, the median cU-Alb was 2.0 μg/min (range 0.6–14.5). Albuminuria makes a flash-like appearance in PUUV infection and returns rapidly to normal levels within 2–3 weeks after fever onset. In the case of AKI, this is a unique phenomenon.

Highlights

The most common hantavirus infection in Europe is hemorrhagic fever with renal syndrome (HFRS) caused by Puumala virus (PUUV) [1]
We found that regardless of the amount of albuminuria or acute kidney injury (AKI) severity during the acute phase of PUUV infection, albuminuria disappears within 2–3 weeks
The present data show that albuminuria, detected in 89% of the patients in this cohort, disappears rapidly, within two to three weeks after acute PUUV infection

Summary

Introduction

The most common hantavirus infection in Europe is hemorrhagic fever with renal syndrome (HFRS) caused by Puumala virus (PUUV) [1]. The reservoir host of this hantavirus is the bank vole (Myodes glareolus), the excreta of which contain the infectious viruses. The virus is transmitted to humans via the inhalation of aerosols contaminated with the virus. Dobrava–Belgrade, Sochi and Seoul viruses, are found in Europe. They cause diseases of varying severity, whereas PUUV predominantly causes a mild form of HFRS. The most severe form of hantavirus infection, the hantavirus cardiopulmonary syndrome (HCPS), occurs in the Americas [2]

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