title: The severity of acute Puumala hantavirus infection does not predict the long-term outcome of patients.
abstract: OBJECTIVE
  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 α(1)-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 α(1)-microglobulin 6 years later compared with those with no α(1)-microglobulin excretion.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Central Hospital of Jyväskylä, Jyväskylä, Finland. marja.miettinen@ksshp.fi
authors.forename: Marja H
authors.initials: MH
authors.lastname: Miettinen
authors.forename: Satu M
authors.initials: SM
authors.lastname: Mäkelä
authors.forename: Ilpo O
authors.initials: IO
authors.lastname: Ala-Houhala
authors.forename: Heini S A
authors.initials: HS
authors.lastname: Huhtala
authors.forename: Mikko A
authors.initials: MA
authors.lastname: Hurme
authors.forename: Tiit
authors.initials: T
authors.lastname: Kööbi
authors.forename: Jukka A
authors.initials: JA
authors.lastname: Partanen
authors.forename: Amos I
authors.initials: AI
authors.lastname: Pasternack
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.forename: Ilkka H
authors.initials: IH
authors.lastname: Pörsti
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Mustonen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000097:blood* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029262:Puumala virus; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome