title: Kidney disease in Puumala hantavirus infection.
abstract: Acute kidney injury (AKI) remains a predominant clinical expression of nephropathia epidemica (NE). Its pathogenesis is not yet fully understood. Here, we describe the tissue injury comprehensively and present new data aimed to characterize the injury and explain its pathophysiology. When compared to tubulointerstitial nephritis of a wide variety of other aetiologies, a high degree of proteinuria is a distinguished trait of NE, a finding that is also helpful in the clinical suspicion of the disease. Recently, novel biomarkers for the prediction of severe AKI, including neutrophil gelatinase-associated lipocalin (NGAL), have been identified and ultrastructural tissue changes have been more accurately described. A role for soluble urokinase-type plasminogen activator (suPAR) in the pathogenesis of NE has been suggested, and data on gene polymorphisms, in relation to the severity of AKI have been presented. Smoking is a risk factor for NE and smoking is also associated with aggravated AKI in NE. Although no specific treatment is in sight, recent case reports concerning therapy directed against vascular permeability and vasodilation are of interest. In fact, future work trying to explain the pathophysiology of AKI might need concentrated efforts towards the mechanisms of increased vascular permeability and vasodilatation, which irrespective of organ manifestation, are two major determinants of NE.
authors.affiliation: a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.|b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
authors.affiliation: a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Outinen
authors.affiliation: a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.|b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Laine
authors.affiliation: a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.|b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Pörsti
authors.affiliation: c Department of Virology, Medicum , University of Helsinki , Helsinki , Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.affiliation: a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.|b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000473:pathology*; D015415:Biomarkers / Q000032:analysis*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000473:pathology* / Q000821:virology*; D006801:Humans; D029262:Puumala virus / Q000302:isolation & purification*
chemical_list: D015415:Biomarkers
keywords: Acute kidney injury; Puumala virus; haematuria; hantavirus infection; proteinuria