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

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.

Increased Heparanase Levels in Urine during Acute Puumala Orthohantavirus Infection Are Associated with Disease Severity

“…Daily white blood cell (WBC), plasma C–reactive protein (CRP) and serum creatinine concentrations were determined at the Laboratory Centre of the Pirkanmaa Hospital District (Tampere, Finland) using standard methods. Daily urine creatinine and albumin concentrations were determined at the University of Massachusetts Memorial Health Care Hospital Labs using standard methods [ 6 ]. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI) equation [ 37 ].…”

“…Proteinuria in NE is mostly composed of albumin, but larger proteins such as IgG are also found in the urine, suggesting proteinuria to have a glomerular origin [ 5 ]. Albuminuria makes a flash–like appearance and returns rapidly to normal levels in 2–3 weeks [ 6 ], and the amount of this albuminuria on admission to hospital predicts the severity of upcoming AKI [ 7 ]. Additionally, a concomitant urinary loss of low–molecular–weight proteins such as β2– and α1–microglobulin indicates that tubular injury also contributes to the proteinuria.…”

Long-Term Consequences of Puumala Hantavirus Infection

“…The prognosis of AKI is favorable and renal function as measured by plasma creatinine concentration, normalizes also in patients with severe AKI [ 15 ]. Albuminuria makes a flash-like appearance, and it returns to normal levels within 2–3 weeks [ 16 ]. In the case of AKI caused by various other etiologies, this is a quite unique phenomenon.…”

Cytokine, Chemokine, and Metalloprotease Activation in the Serum of Patients with Nephropathia Epidemica from the Republic of Tatarstan and the Republic of Mordovia, Russia

“…Nephropathia Epidemica (NE) is a mild form of HFRS that is endemic in the Volga Federal District of Russia, that includes the Republic of Tatarstan (RT) and the Republic of Mordovia (RM) [ 3 , 4 , 5 , 6 ]. Mortality rate is low (0–0.4%) and complete recovery of kidney function without development of chronic renal disease or acute kidney injury (AKI) is commonly expected [ 7 , 8 , 9 ]. Still, NE presents a significant public health concern due to the high incidence of infection and lack of specific treatment [ 10 , 11 ].…”