Glucosuria Predicts the Severity of Puumala Hantavirus Infection

Abstract

Introduction: Puumala hantavirus (PUUV) causes a mild type of hemorrhagic fever with renal syndrome characterized by acute kidney injury (AKI), increased capillary leakage, and thrombocytopenia. Albuminuria and hematuria in dipstick urine test at hospital admission are known to predict the severity of upcoming AKI.

Methods: We analyzed dipstick urine glucose in 195 patients with acute PUUV infection at hospital admission, and divided them into 2 categories according to the presence or absence of glucose in the dipstick urine test. Determinants of disease severity were analyzed in glucosuric and nonglucosuric patients.

Results: Altogether, 24 of 195 patients (12%) had glucosuria. The patients with glucosuria had more severe AKI than patients without glucosuria (median maximum creatinine concentration 459 μmol/l, range 78-1041 μmol/l vs. 166 μmol/l, range 51-1499 μmol/l; P < 0.001). The glucosuric patients had more severe thrombocytopenia (median minimum platelet count 41 × 10⁹/l, range 5-102 × 10⁹/l vs. 62 × 10⁹/l, range 3-249 × 10⁹/l; P = 0.006), and more pronounced signs of increased capillary leakage (change in weight, maximum plasma hematocrit, minimum plasma albumin). The glucosuric patients were more often in clinical shock at admission (20.8% vs. 1.2%; P < 0.001) and the length of hospital stay was longer (median 7.5 days, range 4-22 days vs. 6 days, range 2-30 days; P = 0.009).

Conclusion: Glucosuria is relatively rare, but when present it predicts a more severe disease course in patients with acute PUUV infection.

Keywords: Puumala virus; acute kidney injury; glucosuria; hantavirus; thrombocytopenia.

Figure 1

Distribution of findings in urine dipstick test for hematuria (U-Eryt) and albuminuria (U-Alb) in patients with acute Puumala hantavirus infection as classified to subgroups according to the presence or absence of glucosuria. Glucosuric patients, n = 24; nonglucosuric patients, n = 171.

Figure 2

Maximum plasma creatinine value analyzed according to urine dipstick result: glucosuria (a), albuminuria (b), hematuria (c), and combined result of albuminuria + hematuria + glucosuria (d). The number of patients in each group is indicated in the figure. Boxplots are with median, interquartile range, minimum, and maximum within 1.5 interquartile range, and outliers are displayed as circles and extreme values as asterisks.