title: Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome.
abstract: BACKGROUND
  Puumala hantavirus (PUUV) induces an acute tubulointerstitial nephritis and acute kidney injury (AKI). Our aim was to evaluate the prognosis of severe AKI associated with PUUV infection.
  
  
  METHODS
  We examined 556 patients who were treated at Tampere University Hospital during 1982-2013 for acute, serologically confirmed PUUV infection. Plasma creatinine was measured during hospitalization, convalescence, and 1, 2, and 5 years after the acute infection.
  
  
  RESULTS
  Plasma creatinine concentration was elevated (>100 μmol/l) in 459 (83%) patients, while altogether 189 patients (34%) had severe AKI defined as Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, that is, plasma creatinine ≥353.6 μmol/l (4.0 mg/dl) or need of dialysis. There were no fatal cases during the hospitalization or the following 3 months. Fatality rate during the years following PUUV infection did not differ between patients who had suffered from severe AKI versus those without severe AKI. Post-hospitalization plasma creatinine values were available for 188 (34%) patients. One month after the acute infection, patients with prior severe AKI had higher median plasma creatinine concentration (82 µmol/l, range 54-184) than patients without severe AKI (74 µmol/l, range 55-109, p = 0.005). After 1 year, no significant difference existed in median plasma creatinine concentrations between patients with (71 µmol/l, range 36-123) and without prior severe AKI (72 µmol/l, range 34-116, p = 0.711). After 5 years all but 1 patient had normal creatinine levels.
  
  
  CONCLUSIONS
  In contrast to the worldwide well-accepted KDIGO criteria, severe AKI associated with PUUV infection is not associated with excess fatality but has a very good prognosis, both in the short and long terms.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
authors.forename: Tuula K
authors.initials: TK
authors.lastname: Outinen
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.forename: Jan
authors.initials: J
authors.lastname: Clement
authors.forename: Antti
authors.initials: A
authors.lastname: Paakkala
authors.forename: Ilkka
authors.initials: I
authors.lastname: Pörsti
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005387:Finland / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029262:Puumala virus; D013902:Radiography, Thoracic; D006435:Renal Dialysis / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D003404:Creatinine