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Clinical Practice: Original Paper

Glomerular Proteinuria Predicts the Severity of Acute Kidney Injury in Puumala Hantavirus-Induced Tubulointerstitial Nephritis

Mantula P.S.b · Outinen T.K.b · Clement J.P.G.a · Huhtala H.S.A.c · Pörsti I.H.b, d · Vaheri A.e · Mustonen J.T.b, d · Mäkelä S.M.b, d

Author affiliations

aNational Reference Centre for Hantaviruses, University Hospitals Leuven, Leuven, Belgium; bDepartment of Internal Medicine, Tampere University Hospital, cSchool of Health Sciences, and dFaculty of Medicine and Life Sciences, University of Tampere, Tampere, and eDepartment of Virology, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland

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Nephron 2017;136:193-201

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Article / Publication Details

First-Page Preview
Abstract of Clinical Practice: Original Paper

Received: November 11, 2016
Accepted: February 01, 2017
Published online: March 21, 2017
Issue release date: July 2017

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 2

ISSN: 1660-8151 (Print)
eISSN: 2235-3186 (Online)

For additional information: https://www.karger.com/NEF

Abstract

Background:Puumala virus (PUUV)-induced hemorrhagic fever with renal syndrome is common in many European countries. The typical renal histologic lesion is acute tubulointerstitial nephritis. We examined the type and kinetics of urine protein excretion and prognostic significance of proteinuria for the severity of acute kidney injury (AKI) in acute PUUV infection. Methods: The amount of dipstick albuminuria at hospital admission was analyzed in 205 patients with acute PUUV infection. Dipstick albuminuria at admission was graded into 3 categories: 0-1+, 2+, and 3+. In 70 patients, 24-h urinary excretion of protein, overnight urinary excretion of albumin, immunoglobulin (Ig) G, and α1-microglobulin also were measured over 3 consecutive days during the hospital stay. Results: Maximum median daily proteinuria, overnight albuminuria, and IgG excretion were observed over 5 days, while that of creatinine values was observed 9 days after the onset of the disease. The medians of maximum plasma creatinine levels during hospital stay were different in the 3 categories of dipstick albuminuria: 0-1+: 98 µmol/L (58-1,499), 2+: 139 µmol/L (71-829), and 3+: 363 µmol/L (51-1,285; p < 0.001). Dipstick albuminuria ≥2+ at admission could be detected in 89% of the patients who subsequently developed severe AKI. Glomerular proteinuria, but not tubular proteinuria (α1-microglobulin), correlated with the severity of the emerging AKI. Conclusion: In acute PUUV infection, maximum median proteinuria values preceded the most severe phase of AKI by a few days. A highly useful finding for clinical work was that a quick and simple albuminuria dipstick test at hospital admission predicted the severity of the upcoming AKI.

© 2017 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Clinical Practice: Original Paper

Received: November 11, 2016
Accepted: February 01, 2017
Published online: March 21, 2017
Issue release date: July 2017

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 2

ISSN: 1660-8151 (Print)
eISSN: 2235-3186 (Online)

For additional information: https://www.karger.com/NEF


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