High plasma resistin associates with severe acute kidney injury in Puumala hantavirus infection

Abstract

BackgroundPuumala hantavirus (PUUV) infected patients typically suffer from acute kidney injury (AKI). Adipokines have inflammation modulating functions in acute diseases including AKI. We examined plasma levels of three adipokines (resistin, leptin, and adiponectin) in acute PUUV infection and their associations with disease severity.MethodsThis study included 79 patients hospitalized due to acute PUUV infection. Plasma resistin, leptin, adiponectin, as well as IL-6 and CRP, were measured at the acute phase, recovery phase and one year after hospitalization.ResultsPlasma resistin levels were significantly higher in the acute phase compared to the recovery phase and one year after (median resistin 28 pg/mL (11–107) vs. 17 pg/mL (7–36) vs. 14 pg/mL (7–31), p<0.001). Maximum resistin concentration correlated with maximum plasma creatinine levels (r = 0.63; p<0.001). The higher the amount of albuminuria in the urine dipstick test (0–1+, 2+ or 3+) at admission, the higher the median of maximum resistin (24.7 pg/mL, 25.4 pg/mL and 39.6 pg/mL, respectively, p = 0.002). High resistin was also an independent risk factor for severe AKI (creatinine ≥353.6μmol/L) (OR 1.08, 95% CI 1.02–1.14). Neither plasma leptin nor adiponectin level had any correlation with creatinine concentration or the amount of albuminuria.ConclusionsPlasma resistin independently associates with the severity of AKI in acute PUUV infection. The association of resistin with the amount of albuminuria suggests that the level of plasma resistin is not only influenced by renal clearance but could have some role in the pathogenesis of AKI during PUUV infection.

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

“…As neither the amount of IL-6 nor suPAR in the urine correlated with their plasma concentrations, these mediators were probably also produced locally in the kidneys. Moreover, high plasma levels of the adipocytokine resistin correlated with the amount of albuminuria, determined by urine dipstick analysis at hospital admission, and also with the severity of the upcoming AKI in PUUV-infected patients [14]. Resistin is known as a marker of macrophage activation and considered as a possible link between AKI and inflammatory responses [34].…”

“…Many mediators of inflammation react in acute PUUV infection. In our earlier studies, the higher urinary excretion of interleukin (IL)-6 and soluble form of urokinase-type plasminogen activator receptor (suPAR), as well as a higher plasma adipocytokine resistin concentration, correlated with the amount of albuminuria [12][13][14].…”

Glycoprotein YKL-40 Is Elevated and Predicts Disease Severity in Puumala Hantavirus Infection

“…YKL-40 levels have previously been found to correlate with resistin levels in marathon runners [37]. In addition, high resistin concentrations have been shown to predict severe AKI in PUUV infection [30].…”

“…In the present study, plasma YKL-40 was associated with the severity of AKI, but not directly with the urine dipstick findings. Previously, high plasma resistin, as well as plasma suPAR levels, have been found to be associated with both AKI and proteinuria [10,30]. The exact pathogenesis of AKI in PUUV infection has not been fully elucidated, and the different biomarkers may reflect different pathogenetic mechanisms of AKI in PUUV infection.…”

“…On the contrary, although plasma C-reactive protein (CRP) is elevated in almost all patients with PUUV infection, a high CRP level does not indicate a more severe disease [21]. Recently, we studied the adipokines adiponectin, leptin, and resistin in PUUV infection and found plasma resistin to be an independent risk factor for the severity of AKI [30].…”