Background/Aims: We previously found increased urinary protein excretion, glomerular filtration rate (GFR) and blood pressure in a retrospective analysis of patients with previous nephropathia epidemica (NE). Here, we evaluated the long-term outcome after NE in a prospectively recruited patient group. Methods: Proteinuria, GFR and ambulatory 24-hour blood pressure were assessed 4–7 years (mean 6) after acute NE in 37 patients, and these values were compared to those from 38 seronegative controls. Results: Six years after NE, the prevalence of elevated urinary α1-microglobulin excretion was higher in the patients than controls (9/35 vs. 1/38; p = 0.005). The patients also had higher urinary protein excretion (0.17 ± 0.05 vs. 0.14 ± 0.04 g/day; p = 0.006), GFR (119 ± 19 vs. 109 ± 14 ml/min/1.73 m2; p = 0.016) and mean systolic (123 ± 11 vs. 117 ± 9 mm Hg; p = 0.012), nighttime systolic (109 ± 11 vs. 100 ± 9 mm Hg; p = 0.001) and nighttime diastolic blood pressure (70 ± 7 vs. 66 ± 7 mm Hg; p = 0.035) than the controls. Conclusions: These results confirm our previous findings of a higher prevalence of tubular proteinuria and increased urinary protein excretion, GFR and systolic blood pressure 6 years after acute NE.

Keywords:
Acute interstitial nephritis, Glomerular filtration, Hemorrhagic fever of renal syndrome, Nephropathia epidemica, Puumala hantavirus
1.
Vapalahti O, Mustonen J, Lundkvist Å, Henttonen O, Plyusnin A, Vaheri A: Hantavirus infections in Europe. Lancet Infect Dis 2003;3:653–661.
2.
Muranyi W, Bahr U, Zeier M, van der Woude FJ: Hantavirus infection. J Am Soc Nephrol 2005;16:3669–3679.
3.
Lähdevirta J: Nephropathia epidemica in Finland. A clinical histological and epidemiological study. Ann Clin Res 1971;3:1–54.
4.
Mustonen J, Brummer-Korvenkontio M, Hedman K, Pasternack A, Pietilä K, Vaheri A: Nephropathia epidemica in Finland: a retrospective study of 126 cases. Scand J Infect Dis 1994;26:7–13.
5.
Settergren B: Clinical aspects of nephropathia epidemica (Puumala virus infection) in Europe: a review. Scand J Infect Dis 2000;32:125–132.
6.
Mustonen J, Helin H, Pietilä K, Brummer-Korvenkontio M, Hedman K, Vaheri A, Pasternack A: Renal biopsy findings and clinicopathologic correlations in nephropathia epidemica. Clin Nephrol 1994;41:121–126.
7.
Mäkelä S, Ala-Houhala I, Mustonen J, Koivisto AM, Kouri T, Turjanmaa V, Vapalahti O, Vaheri A, Pasternack A: Renal function and blood pressure five years after puumala virus-induced nephropathy. Kidney Int 2000;58:1711–1718.
8.
Miettinen MH, Mäkelä SM, Ala-Houhala IO, Huhtala HS, Kööbi T, Vaheri AI, Pasternack AI, Pörsti IH, Mustonen JT: Ten-year prognosis of Puumala hantavirus-induced acute interstitial nephritis. Kidney Int 2006;69:2043–2048.
9.
Vapalahti O, Lundkvist Å, Kallio-Kokko H, Paukku K, Julkunen I, Lankinen H, Vaheri A: Antigenic properties and diagnostic potential of puumala virus nucleocapsid protein expressed in insect cells. J Clin Microbiol 1996;34:119–125.
10.
Forouhi NG, Balkau B, Borch-Jonsen K, Dekker J, Glumer C, Qiao Q, Spijkerman A, Stolk R, Tabac A, Wareham NJ: The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group. Diabetologia 2006;49:822–827.
11.
Vervoort G, Veldman B, Berden JHM, Smits P, Wetzels JFM: Glomerular hyperfiltration in type 1 diabetes mellitus results from primary changes in proximal tubular sodium handling without changes in volume expansion. Eur J Clin Invest 2005;35:330–336.
12.
Staessen J, O’Brien E, Amery A, Atkins N, Baumgart P, De Cort P, Degaute JP, Dolenc P, De Gaudemaris R, Enstrom I, et al: Ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database. J Hypertens 1994;12(suppl):S1–S12.
13.
Ala-Houhala I, Koskinen M, Ahola T, Harmoinen A, Kouri T, Laurila K, Mustonen J, Pasternack A: Increased glomerular permeability in patients with nephropathia epidemica caused by Puumala hantavirus. Nephrol Dial Transplant 2002;17:246–252.
14.
Ledina D, Bradaric N, Ivic I, Marasovic D, Radovic D, Ostojic-Bakotin V, Prgomet S: Is permanent renal function damage possible after hemorrhagic fever with renal syndrome? (in Croatian). Acta Med Croatica 2003;57:365–368.
15.
Lähdevirta J, Collan Y, Jokinen EJ, Hiltunen R: Renal sequelae to nephropathia epidemica. Acta Pathol Microbiol Scand [A] 1978;86:265–271.
16.
Brenner BM, Rector FC (eds): The Kidney. Philadelphia, WB Saunders, 2004.
17.
Mogensen CE: Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987;31:673–689.
18.
Wirta OR, Pasternack AI: Glomerular filtration rate and kidney size in type 2 (non-insulin-dependent) diabetes mellitus. Clin Nephrol 1995;44:1–7.
19.
Schmieder RE, Veelken R, Schobel H, Dominiak P, Mann JF, Luft FC: Glomerular hyperfiltration during sympathetic nervous system activation in early essential hypertension. J Am Soc Nephrol 1997;8:893–900.
20.
Wong H, Vivian L, Weiler G, Filler G: Patients with autosomal dominant polycystic kidney disease hyperfiltrate early in their disease. Am J Kidney Dis 2004;43:624–628.
21.
Palatini P, Mormino P, Dorifatti F, Santonastaso M, Mos L, De Toni R, Winnicki M, Dal Follo M, Biasion T, Garavelli G, Pessina AC: Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1 hypertension: the HARVEST. Kidney Int 2006;70:578–584.
22.
Rippe B: Is there an increased long-term risk of hypertension and renal impairment after Puumala virus-induced nephropathy? Kidney Int 2006;69:1930–1931.
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2009
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