title: Hantavirus infection with severe proteinuria and podocyte foot-process effacement.
abstract: Nephropathia epidemica, a zoonosis caused by Hantavirus infection (most commonly subtype Puumala) is associated with flu-like symptoms and acute kidney failure. Kidney manifestations are characterized predominantly by tubulointerstitial nephritis, hemorrhage into medullary tissues, interstitial edema, and tubular cell necrosis. Kidney failure is accompanied by proteinuria, and in some cases, nephrotic-range proteinuria may occur. However, the cellular mechanisms of proteinuria remain to be elucidated. We describe a Hantavirus (Puumala) infection in a 27-year-old man with acute kidney failure and severe and rapidly reversible proteinuria. Light microscopy of a kidney biopsy specimen showed only minor changes of glomeruli. However, transmission electron microscopy revealed podocyte foot-process effacement. Immunofluorescence staining of the slit diaphragm protein podocin and the tight junction protein ZO-1 revealed a partial mislocalization of these proteins. Together, these findings highlight that Hantavirus infection may perturb podocyte integrity, resulting in glomerular proteinuria. These alterations of podocytes and consequently the glomerular filtration barrier may be transient and resolve within weeks.
authors: Department of Nephrology, University Hospital, Freiburg, Germany.
authors: Christopher
authors: C
authors: Boehlke
authors: Department of Nephrology, University Hospital, Freiburg, Germany; Institute of Pathology, University Hospital Hamburg-Eppendorf, Germany.
authors: Björn
authors: B
authors: Hartleben
authors: Department of Nephrology, University Hospital, Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Albert-Ludwigs-University Freiburg, Germany.
authors: Tobias B
authors: TB
authors: Huber
authors: Department of Pathology, University Hospital, Basel, Switzerland.
authors: Helmut
authors: H
authors: Hopfer
authors: Department of Nephrology, University Hospital, Freiburg, Germany.
authors: Gerd
authors: G
authors: Walz
authors: Department of Nephrology, University Hospital, Freiburg, Germany. Electronic address: elke.neumann-haefelin@uniklinik-freiburg.de.
authors: Elke
authors: E
authors: Neumann-Haefelin
mesh_terms: D000328:Adult; D018778:Hantavirus Infections / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008297:Male; D050199:Podocytes / Q000473:pathology*; D011507:Proteinuria / Q000150:complications* / Q000473:pathology*; D012720:Severity of Illness Index
keywords: Hantavirus infection; acute kidney failure; podocyte foot-process effacement; proteinuria