Tuula K Outinen1, Paula Mantula1, Outi K Laine1,2, Ilkka Pörsti1,2, Antti Vaheri3, Satu M Mäkelä1,2, Jukka Mustonen1,2. 1. a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland. 2. b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland. 3. c Department of Virology , Medicum, University of Helsinki , Helsinki , Finland.
Abstract
BACKGROUND: Puumala hantavirus (PUUV) causes haemorrhagic fever with renal syndrome characterized by thrombocytopenia, capillary leakage and acute kidney injury (AKI) with proteinuria and haematuria. Although the typical histologic lesion is acute tubulointerstitial nephritis, the amount of glomerular proteinuria predicts the severity of upcoming AKI. Here, we studied the associations of haematuria and proteinuria with the severity of emerging AKI, thrombocytopenia and markers of coagulation and fibrinolysis in PUUV infection. METHODS: We examined 205 consecutive patients treated for serologically confirmed acute PUUV infection at Tampere University Hospital during 1997-2014. The patients were divided into three groups according to the combined positive result in urine haemoglobin and albumin dipstick tests: 0-2 + (n = 58), 3-4 + (n = 100) and 5-6 + (n = 47). RESULTS: The medians of maximum creatinine concentrations in the three groups were: 0-2 + 100 μmol/L (range 52-1499), 3-4 + 204 μmol/L (range 65-1071) and 5-6 + 361 μmol/l (range 51-1285) (p < .001). The number of blood platelets (p = .069), and the levels of fibrinogen, prothrombin fragments F1 + 2 and d-dimer (p = .602, p = .113, p = .289, respectively) were not significantly different between the groups. When the amount of haematuria in the dipstick test was examined separately, no association with thrombocytopenia was detected (p = .307 between groups 0, 1+ and 2-3+). CONCLUSIONS: Combined positive result of haematuria and proteinuria in the dipstick test at hospital admission predicted the severity of upcoming AKI in acute PUUV infection. As haematuria was not associated with the severity of thrombocytopenia, it did not indicate increased bleeding tendency, but was rather a marker of acute kidney injury.
BACKGROUND:Puumala hantavirus (PUUV) causes haemorrhagic fever with renal syndrome characterized by thrombocytopenia, capillary leakage and acute kidney injury (AKI) with proteinuria and haematuria. Although the typical histologic lesion is acute tubulointerstitial nephritis, the amount of glomerular proteinuria predicts the severity of upcoming AKI. Here, we studied the associations of haematuria and proteinuria with the severity of emerging AKI, thrombocytopenia and markers of coagulation and fibrinolysis in PUUV infection. METHODS: We examined 205 consecutive patients treated for serologically confirmed acute PUUV infection at Tampere University Hospital during 1997-2014. The patients were divided into three groups according to the combined positive result in urine haemoglobin and albumin dipstick tests: 0-2 + (n = 58), 3-4 + (n = 100) and 5-6 + (n = 47). RESULTS: The medians of maximum creatinine concentrations in the three groups were: 0-2 + 100 μmol/L (range 52-1499), 3-4 + 204 μmol/L (range 65-1071) and 5-6 + 361 μmol/l (range 51-1285) (p < .001). The number of blood platelets (p = .069), and the levels of fibrinogen, prothrombin fragments F1 + 2 and d-dimer (p = .602, p = .113, p = .289, respectively) were not significantly different between the groups. When the amount of haematuria in the dipstick test was examined separately, no association with thrombocytopenia was detected (p = .307 between groups 0, 1+ and 2-3+). CONCLUSIONS: Combined positive result of haematuria and proteinuria in the dipstick test at hospital admission predicted the severity of upcoming AKI in acute PUUV infection. As haematuria was not associated with the severity of thrombocytopenia, it did not indicate increased bleeding tendency, but was rather a marker of acute kidney injury.
Authors: Felix C Koehler; Veronica Di Cristanziano; Martin R Späth; K Johanna R Hoyer-Allo; Manuel Wanken; Roman-Ulrich Müller; Volker Burst Journal: Clin Kidney J Date: 2022-01-29
Authors: Paula S Mantula; Tuula K Outinen; Pia Jaatinen; Mari Hämäläinen; Heini Huhtala; Ilkka H Pörsti; Antti Vaheri; Jukka T Mustonen; Satu M Mäkelä Journal: PLoS One Date: 2018-12-05 Impact factor: 3.240
Authors: Johanna Tietäväinen; Paula Mantula; Tuula Outinen; Heini Huhtala; Ilkka H Pörsti; Onni Niemelä; Antti Vaheri; Satu Mäkelä; Jukka Mustonen Journal: Kidney Int Rep Date: 2019-05-31
Authors: Tuula K Outinen; Paula Mantula; Pia Jaatinen; Mari Hämäläinen; Eeva Moilanen; Antti Vaheri; Heini Huhtala; Satu Mäkelä; Jukka Mustonen Journal: Viruses Date: 2019-08-21 Impact factor: 5.048
Authors: Paula Mantula; Johanna Tietäväinen; Jan Clement; Onni Niemelä; Ilkka Pörsti; Antti Vaheri; Jukka Mustonen; Satu Mäkelä; Tuula Outinen Journal: Pathogens Date: 2020-07-28