Potential renal sequelae in survivors of hantavirus cardiopulmonary syndrome

Abstract

Although other hantaviruses are associated with renal manifestations, hantavirus cardiopulmonary syndrome (HCPS) has not been associated with such sequelae. The HCPS survivors were prospectively evaluated for renal complications. Subjects underwent yearly evaluation, laboratory studies, and 24-hour urine collection. Thirty subjects were evaluated after recovery from HCPS with the first follow-up at a median of 7.4 months after discharge. Subjects were a wide age range (18-51) but had an equal gender composition. Eighteen of 30 (60%) returned for > 1 evaluation. Half (15/30) had a 24-hour urine collection with > 150 mg of total protein and 6 had > 300 mg. Seven had a Cockcroft-Gault creatinine clearance (CrClCG) < 90 mL/min/1.73 m2 and 2 were < 60. Fifty-three percent met the definition of chronic kidney disease. Those treated with extracorporeal membrane oxygenation had less renal sequelae (P = 0.035). Our data suggest that renal sequelae may occur in HCPS. Further study of renal complications of New World hantavirus infections are needed.

Figure 1

Timing of testing and results in subjects with proteinuria (> 150 mg/24 hours). □, White squares indicate when testing no proteinuria (N) detected (< 150 mg/dL); ■, black squares indicate when testing proteinuria (P) detected (> 150 mg/24 hours); ⊠, indicates a missed urine sample; ?, indicates start date of acute hantavirus cardiopulmonary syndrome (HCPS) unknown; and indicates range of follow-up. * Equals first number of range of four months; ID = identification number.

Figure 2

Timing of testing and results in subjects with decreased creatinine clearance (< 90 mL/min/1.73 m²). ◣, indicates when 24-hour creatinine clearance < 90 mL/min/1.73² (black = yes, white = no); ◥, indicates when testing Cockcroft-Gault creatinine clearance < 90 mL/min/1.73 m² (black = yes, white = no); , indicates missed sample; ?, indicates start date of acute hantavirus cardiopulmonary syndrome (HCPS) unknown, and indicates range of follow-up. * Equals first number of range of four months. † Identification numbers (ID) are linked to specific subjects in Figure 1.