title: Glomerular filtration rate and tubular involvement during acute disease and convalescence in patients with nephropathia epidemica.
abstract: Glomerular filtration rate (GFR) and tubular involvement were studied in 74 patients with serologically verified nephropathia epidemica (NE). Increased levels of serum creatinine and serum beta 2-microglobulin were documented in 96% and 99% of the patients, respectively. The mean of the lowest estimated GFR was 26 ml/min. Proximal tubular reabsorptive capacity was assessed by urinary loss of beta 2-microglobulin and cell damage by urinary activity of N-acetyl-beta-D-glucosaminidase. Both of these parameters were elevated in most of the patients during the acute phase of the disease. Increased serum levels of Tamm-Horsfall-specific IgG and/or IgA occurred in 72 of 74 patients. No patient required dialysis and there was no mortality. Six months after discharge only three patients had a GFR less than 80 ml/min as estimated by [51Cr]EDTA clearance; two of these had underlying chronic diseases and one had suffered clinically severe NE. Desmopressin tests showed decreased urine osmolarity in three patients 8 months after discharge. These three had chronic diseases, which may have contributed to the impaired tubular function. Thus, there was a markedly decreased GFR and a tubular dysfunction in the acute phase of NE. Most patients recovered within a few months and none showed evidence of chronically impaired renal function due to NE.
authors.affiliation: Department of Infectious Diseases, University of Umeå, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Settergren
authors.forename: B
authors.initials: B
authors.lastname: Trollfors
authors.forename: A
authors.initials: A
authors.lastname: Fasth
authors.forename: B
authors.initials: B
authors.lastname: Hultberg
authors.forename: S R
authors.initials: SR
authors.lastname: Norrby
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003894:Deamino Arginine Vasopressin; D005260:Female; D005919:Glomerular Filtration Rate; D006480:Hemorrhagic Fever with Renal Syndrome / Q000503:physiopathology*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007684:Kidney Tubules / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009088:Mucoproteins / Q000276:immunology; D009994:Osmolar Concentration; D058949:Uromodulin; D001613:beta 2-Microglobulin / Q000032:analysis / Q000652:urine
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D009088:Mucoproteins; C548612:UMOD protein, human; D058949:Uromodulin; D001613:beta 2-Microglobulin; D003404:Creatinine; D000118:Acetylglucosaminidase; D003894:Deamino Arginine Vasopressin