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Acute kidney injury and hantavirus disease 

Acute kidney injury and hantavirus disease
Chapter:
Acute kidney injury and hantavirus disease
Author(s):

Jan Clement

DOI:
10.1093/med/9780199592548.003.0242_update_001

Update:

The entire chapter has been updated with relevant publications starting from 2012, up to end 2016. Of particular interest is the reworked Epidemiology section, proving that the grand total of officially registered AKI cases due to hantavirus infection has now passed the cape of 2 million worldwide, a fact sill heavily underestimated or even ignored in current nephrological literature.

19 new references, deleted 2 references

Updated on 28 June 2018. The previous version of this content can be found here.
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date: 21 September 2019

Hantavirus disease or at least its renal form, the so-called haemorrhagic fever with renal syndrome is the only globally emerging acute kidney injury (AKI) form, and currently without doubt the most underestimated form of community-acquired AKI. Hantavirus disease is a viral zoonosis, caused by inhalation of infectious aerosolized excreta from chronically infected rodents, which are both the reservoir and the vector of different hantavirus species. Clinical presentation consists of sudden flu-like symptoms (fever, headache, myalgia), followed by gastrointestinal discomfort and AKI, often with anuria or oliguria. More rarely, acute myopia and/or non-cardiogenic acute lung oedema or injury is the presenting or complicating symptom. Laboratory hallmarks are initial thrombocytopenia and proteinuria, raised C-reactive protein and lactate dehydrogenase, left-shift leucocytosis, and typical but transient serum lipid disturbances. Spontaneous remission occurs within 2–3 weeks without sequelae. Case fatality rate is between 0.1% and 15% according to the infecting hantavirus species, but most infections show in fact an asymptomatic or paucisymptomatic presentation. Treatment is only supportive, but may necessitate life-saving intensive care techniques. Together with leptospirosis, haemorrhagic fever with renal syndrome is the only form of AKI against which different vaccines are in use, but a World Health Organization-licensed hantavirus vaccine is still lacking.

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