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Cystatin C and α-1-Microglobulin Predict Severe Acute Kidney Injury in Patients with Hemorrhagic Fever with Renal Syndrome

Authors
  • Hansson, Magnus1
  • Gustafsson, Rasmus
  • Jacquet, Chloé2, 3
  • Chebaane, Nedia2
  • Satchell, Simon
  • Thunberg, Therese2
  • Ahlm, Clas2
  • Fors Connolly, Anne-Marie2, 3
  • 1 Department of Laboratory Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
  • 2 (C.A.)
  • 3 Molecular Infection Medicine Sweden (MIMS), Umeå University, 90187 Umeå, Sweden
Type
Published Article
Journal
Pathogens
Publisher
MDPI
Publication Date
Aug 18, 2020
Volume
9
Issue
8
Identifiers
DOI: 10.3390/pathogens9080666
PMID: 32824680
PMCID: PMC7460112
Source
PubMed Central
Keywords
License
Green

Abstract

Puumala orthohantavirus causes hemorrhagic fever with renal syndrome (HFRS) characterized by acute kidney injury (AKI), an abrupt decrease in renal function. Creatinine is routinely used to detect and quantify AKI; however, early AKI may not be reflected in increased creatinine levels. Therefore, kidney injury markers that can predict AKI are needed. The potential of the kidney injury markers urea, cystatin C, α1-microglobulin (A1M) and neutrophil gelatinase-associated lipocalin (NGAL) to detect early AKI during HFRS was studied by quantifying the levels of these markers in consecutively obtained plasma (P) and urine samples (U) for 44 HFRS patients. P-cystatin C and U-A1M levels were significantly increased during early HFRS compared to follow-up. In a receiver operating characteristic (ROC) curve analysis, P-cystatin C, U-A1M and P-urea predicted severe AKI with area under the curve 0.72, 0.73 and 0.71, respectively, whereas the traditional kidney injury biomarkers creatinine and U-albumin did not predict AKI. Nearly half of the HFRS patients (41%) fulfilled the criteria for shrunken pore syndrome, which was associated with the level of inflammation as measured by P-CRP. P-cystatin C and U-A1M are more sensitive and earlier markers compared to creatinine in predicting kidney injury during HFRS.

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