The Severity of Acute Puumala Hantavirus Infection Does Not Predict the Long-Term Outcome of Patients

Abstract

Background/Aims: We have found greater urinary protein excretion and higher glomerular filtration rate (GFR) and blood pressure in patients 6 years after acute nephropathia epidemica (NE) compared with seronegative controls. The present aim was to establish whether the long-term outcome is determined by the severity of acute illness. Methods: Serial plasma interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), creatinine, C-reactive protein, blood cell count as well as 24-hour urinary protein and overnight α₁-microglobulin and albumin excretions were measured in 37 patients with acute NE. Human leucocyte antigen (HLA)-B, HLA-DRB1, TNF-α(–308) and IL-6(–174) alleles were also analyzed. After 6 years, GFR, blood pressure and urinary protein excretion were examined. Results: There were no associations between the clinical severity of acute NE or the genetic factors determined and the increased GFR, hypertension or 24-hour urinary protein excretion observed 6 years later. The degree of inflammation during the acute phase was higher in patients who had increased urinary excretion of α₁-microglobulin 6 years later compared with those with no α₁-microglobulin excretion. Conclusion: Neither the severity of acute NE nor the host genetic factors determined the predicted renal function, blood pressure or 24-hour urinary protein excretion 6 years later.

Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome

“…Nevertheless, although the general prognosis of PUUV infection is positive, the development of a chronic hormonal deficit following PUUV infection with pituitary involvement remains a possibility [41]. The long-term outcome, with reference to renal function, blood pressure, urinary protein excretion or the occurrence of hormonal defects, cannot be predicted by the clinical severity of acute PUUV infection [33,41]. …”

“…The study cohort consisted of 556 PUUV-infected patients, who had participated in our previous clinical studies [12,17,18,19,24,25,26,27,28,29,30,31,32,33,34,37,38,39,40,41]. The diagnosis of acute PUUV infection was serologically confirmed in all cases.…”

“…Furthermore, urinary IL-6 and suPAR excretion correlate with proteinuria, which possibly reflects the local production of these molecules in the kidney [31,32]. Nevertheless, the long-term prognosis of acute PUUV infection has been shown to be favorable and is not predicted by the clinical severity of the acute infection [33,34]. …”

Long‐term hormonal follow‐up after human Puumala hantavirus infection

“…Human PUUV infection causes a mild form of HFRS, and the majority of patients recover without any long‐term consequences . However, transient symptoms related with central nervous system (CNS) involvement are common and cases of pituitary haemorrhage followed by hypopituitarism have been described .…”

Hantavirus protein interactions regulate cellular functions and signaling responses

“…A follow-up 10 years after PUUVinfection revealed no clear long-term consequences [68], suggesting that hantaviruses normally do not cause long-term consequences. Furthermore, it was recently shown that there is no correlation between severity of acute PUUV-caused HFRS and long-term outcome of patients [69], suggesting that, if there are long-term consequences of hantavirus infection, hitherto unknown factors determine the long-term outcome. In contrast to what is observed in natural hosts [9,70], viremia during HFRS/HCPS is believed to be transient.…”