Haematuria is a marker for the severity of acute kidney injury but does not associate with thrombocytopenia in acute Puumala hantavirus infection

Outinen, Tuula; Mantula, Paula; Laine, Outi; Pörsti, Ilkka; Vaheri, Antti; Mäkelä, Satu; Mustonen, Jukka

doi:10.1080/23744235.2017.1358461

Cited by 10 publications

(12 citation statements)

References 23 publications

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“…We have previously shown that albuminuria and hematuria in dipstick urine test predict the severity of upcoming AKI in patients with acute PUUV infection 7, 8. We now report that glucosuria in these patients is an even stronger predictor of disease severity.…”

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confidence: 53%

Glucosuria Predicts the Severity of Puumala Hantavirus Infection

Tietäväinen

Mantula

Outinen

et al. 2019

Kidney International Reports

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IntroductionPuumala hantavirus (PUUV) causes a mild type of hemorrhagic fever with renal syndrome characterized by acute kidney injury (AKI), increased capillary leakage, and thrombocytopenia. Albuminuria and hematuria in dipstick urine test at hospital admission are known to predict the severity of upcoming AKI.MethodsWe analyzed dipstick urine glucose in 195 patients with acute PUUV infection at hospital admission, and divided them into 2 categories according to the presence or absence of glucose in the dipstick urine test. Determinants of disease severity were analyzed in glucosuric and nonglucosuric patients.ResultsAltogether, 24 of 195 patients (12%) had glucosuria. The patients with glucosuria had more severe AKI than patients without glucosuria (median maximum creatinine concentration 459 μmol/l, range 78–1041 μmol/l vs. 166 μmol/l, range 51–1499 μmol/l; P < 0.001). The glucosuric patients had more severe thrombocytopenia (median minimum platelet count 41 × 109/l, range 5–102 × 109/l vs. 62 × 109/l, range 3–249 × 109/l; P = 0.006), and more pronounced signs of increased capillary leakage (change in weight, maximum plasma hematocrit, minimum plasma albumin). The glucosuric patients were more often in clinical shock at admission (20.8% vs. 1.2%; P < 0.001) and the length of hospital stay was longer (median 7.5 days, range 4–22 days vs. 6 days, range 2–30 days; P = 0.009).ConclusionGlucosuria is relatively rare, but when present it predicts a more severe disease course in patients with acute PUUV infection.

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confidence: 53%

Glucosuria Predicts the Severity of Puumala Hantavirus Infection

Tietäväinen

Mantula

Outinen

et al. 2019

Kidney International Reports

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Section: Discussionmentioning

confidence: 99%

“…In PUUV infection, the flash-like appearance of albuminuria and the association between albuminuria quantity with upcoming AKI severity [ 6 , 11 ] are unique findings in the context of AKI. In addition, the amount of hematuria associates with the severity of AKI in PUUV infection [ 35 ]. The presence of glucosuria, detected in 12% of the patients, was a strong predictive factor not only for clinical shock, but also the severity of AKI in acute PUUV infection [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…We found a prevalence of 50% hematuria at admission, whereas other studies have reported prevalences of 25%–58% ( 11 , 23 , 27 ). At least 1 study found an association between hematuria (but not thrombocytopenia) and progression to severe AKI ( 28 ). Hematuria is also considered a marker of NE severity predictive of polyuria ( 29 ).…”

Section: Discussionmentioning

confidence: 99%