title: The degree of leukocytosis and urine GATA-3 mRNA levels are risk factors for severe acute kidney injury in Puumala virus nephropathia epidemica.
abstract: Puumala hantavirus (PUUV) infection, also known as nephropathia epidemica, is the most common cause of hemorrhagic fever with renal syndrome (HFRS) in Europe. The pathogenesis of PUUV nephropathia epidemica is complex and multifactorial, and the risk factors for severe acute kidney injury (AKI) during acute PUUV infection are not well defined. We conducted a prospective study of hospitalized patients with PUUV infection in Tampere, Finland to identify acute illness risk factors for HFRS severity. Serial daily blood and urine samples were collected throughout acute illness and at 2 week and 6 month convalescent visits. By univariate analyses, the maximum white blood cell count during acute illness was a risk factor for severe AKI. There were no significant associations between PUUV-induced AKI severity and platelet counts, C-reactive protein, or alanine aminotransferase levels. Maximum plasma interleukin (IL)-6, urine IL-6, and urine IL-8 concentrations were positively associated with PUUV-induced AKI. Finally, the maximum urinary sediment GATA-3 mRNA level was positively correlated with the peak fold-change in serum creatinine, regardless of AKI severity classification. By multivariate analyses, we found that the maximum levels of leukocytes and urinary sediment GATA-3 mRNA during acute illness were independent risk factors for severe PUUV-induced AKI. We have identified novel acute illness risk factors for severe PUUV-induced AKI.
authors.affiliation: Department of Medicine, Medical School, University of Massachusetts, Worcester, Massachusetts, United States of America. daniel.libraty@umassmed.edu
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Libraty
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vlk
authors.forename: Mikko
authors.initials: M
authors.lastname: Hurme
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.forename: Francis A
authors.initials: FA
authors.lastname: Ennis
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005387:Finland; D050990:GATA3 Transcription Factor / Q000652:urine*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications* / Q000473:pathology / Q000652:urine; D006801:Humans; D015850:Interleukin-6 / Q000097:blood / Q000652:urine; D016209:Interleukin-8 / Q000652:urine; D007902:Length of Stay; D007964:Leukocytosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029262:Puumala virus; D012333:RNA, Messenger / Q000652:urine; D012307:Risk Factors
chemical_list: D050990:GATA3 Transcription Factor; D015850:Interleukin-6; D016209:Interleukin-8; D012333:RNA, Messenger; D003404:Creatinine