The kidney in hantavirus infection-epidemiology, virology, pathophysiology, clinical presentation, diagnosis and management.
Felix Carlo KoehlerVeronica Di CristanzianoMartin R SpäthK Johanna R Hoyer-AlloManuel WankenRoman-Ulrich MüllerVolker BurstPublished in: Clinical kidney journal (2022)
Hantavirus-induced diseases are emerging zoonoses with endemic appearances and frequent outbreaks in different parts of the world. In humans, hantaviral pathology is characterized by the disruption of the endothelial cell barrier followed by increased capillary permeability, thrombocytopenia due to platelet activation/depletion and an overactive immune response. Genetic vulnerability due to certain human leukocyte antigen haplotypes is associated with disease severity. Typically, two different hantavirus-caused clinical syndromes have been reported: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). The primarily affected vascular beds differ in these two entities: renal medullary capillaries in HFRS caused by Old World hantaviruses and pulmonary capillaries in HCPS caused by New World hantaviruses. Disease severity in HFRS ranges from mild, e.g. Puumala virus-associated nephropathia epidemica, to moderate, e.g. Hantaan or Dobrava virus infections. HCPS leads to a severe acute respiratory distress syndrome with high mortality rates. Due to novel insights into organ tropism, hantavirus-associated pathophysiology and overlapping clinical features, HFRS and HCPS are believed to be interconnected syndromes frequently involving the kidneys. As there are no specific antiviral treatments or vaccines approved in Europe or the USA, only preventive measures and public awareness may minimize the risk of hantavirus infection. Treatment remains primarily supportive and, depending on disease severity, more invasive measures (e.g., renal replacement therapy, mechanical ventilation and extracorporeal membrane oxygenation) are needed.
Keyphrases
- acute respiratory distress syndrome
- extracorporeal membrane oxygenation
- mechanical ventilation
- endothelial cells
- respiratory failure
- immune response
- high glucose
- intensive care unit
- acute kidney injury
- pulmonary hypertension
- gene expression
- early onset
- risk factors
- drug induced
- induced pluripotent stem cells
- dendritic cells
- vascular endothelial growth factor
- type diabetes
- emergency department
- copy number
- dna methylation
- oxidative stress
- coronary artery disease
- replacement therapy