Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and proteinuria predict severity of acute kidney injury in Puumala virus infection.
BACKGROUND
Nephropathia epidemica (NE) is a mild form of hemorrhagic fever with renal syndrome (HFRS) that is caused by the Puumala virus. Periodic outbreaks have been described in endemic areas, with a substantial number of previously healthy individuals developing acute kidney injury (AKI). There is a considerable diversity in the clinical course of the disease, and few patients require renal replacement therapy.


METHODS
We tested whether urinary neutrophil gelatinase associated lipocalin (uNGAL), urine albumin/creatinine ratio (uACR), urine protein/creatinine ratio (uPCR), urine dipstick protein, C-reactive protein, procalcitonin, leukocyte and platelet count, determined on admission to the hospital, can predict the severity of AKI. Sixty-one patients were analyzed during admission in the emergency department.


RESULTS
The variables most strongly associated with peak plasma creatinine concentration were uNGAL (β = 0.70, p <0.0001), uPCR (β = 0.64, p = 0.001), uACR (β = 0.61, p = 0.002), and dipstick proteinuria (β = 0.34, p = 0.008). The highest AUC-ROC to predict stage 3 AKI according to the acute kidney injury network's (AKIN) classification was seen for uNGAL (0.81, p = 0.001).


CONCLUSIONS
uNGAL accurately predicts the severity of AKI in NE. This could help emergency room physicians predict disease severity and allow for initial risk stratification.
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. hanno.bunz@med.uni-tuebingen.de.
Hanno
H
Bunz
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. pweyrich@hotmail.com.
Peter
P
Weyrich
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. andreas.peter@med.uni-tuebingen.de.|Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany. andreas.peter@med.uni-tuebingen.de.|German Center for Diabetes Research (DZD), Tübingen, Germany. andreas.peter@med.uni-tuebingen.de.
Andreas
A
Peter
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. dorothea.baumann@med.uni-tuebingen.de.
Dorothea
D
Baumann
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. otto.tschritter@vinzenz.de.
Otto
O
Tschritter
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. martina.guthoff@med.uni-tuebingen.de.
Martina
M
Guthoff
Institute of Medical Virology and Epidemiology of Viral Diseases, Eberhard Karls University, Tübingen, Germany. robert.beck@med.uni-tuebingen.de.
Robert
R
Beck
Institute of Medical Virology and Epidemiology of Viral Diseases, Eberhard Karls University, Tübingen, Germany. gerhard.jahn@med.uni-tuebingen.de.
Gerhard
G
Jahn
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. ferruh.artunc@med.uni-tuebingen.de.
Ferruh
F
Artunc
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. hans-ulrich.haering@med.uni-tuebingen.de.|Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany. hans-ulrich.haering@med.uni-tuebingen.de.|German Center for Diabetes Research (DZD), Tübingen, Germany. hans-ulrich.haering@med.uni-tuebingen.de.
Hans-Ulrich
HU
Häring
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. nils.heyne@med.uni-tuebingen.de.
Nils
N
Heyne
Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital of the Eberhard Karls University, Tübingen, Germany. robert.wagner@med.uni-tuebingen.de.|Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen (IDM), Tübingen, Germany. robert.wagner@med.uni-tuebingen.de.|German Center for Diabetes Research (DZD), Tübingen, Germany. robert.wagner@med.uni-tuebingen.de.
Robert
R
Wagner
D058186:Acute Kidney Injury / Q000209:etiology / Q000652:urine / Q000821:virology; D000209:Acute-Phase Proteins / Q000652:urine*; D000328:Adult; D000419:Albuminuria / Q000209:etiology; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D003404:Creatinine / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000209:etiology* / Q000821:virology; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors; D011507:Proteinuria / Q000209:etiology*; D011518:Proto-Oncogene Proteins / Q000652:urine*; D029262:Puumala virus / Q000472:pathogenicity*; D012189:Retrospective Studies
D000209:Acute-Phase Proteins; D015415:Biomarkers; C000606589:CALCA protein, human; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011498:Protein Precursors; D011518:Proto-Oncogene Proteins; D002116:Calcitonin; D002097:C-Reactive Protein; D003404:Creatinine; D015740:Calcitonin Gene-Related Peptide