Proteinuria and the Clinical Course of Dobrava-Belgrade Hantavirus Infection

Purpose: Human infection with Dobrava-Belgrade virus (DOBV) in Northern Germany causes a mild form of hantavirus disease predominantly characterized by acute kidney injury due to interstitial nephritis. We evaluated the largest number of DOBV-infected patients so far regarding clinical course, proteinuria, and prognostic markers. Patients and Methods: Patients with DOBV-associated hantavirus disease admitted to the Renal Division of the University of Lübeck (Germany) between 1997 and 2012 were included in this study. Symptoms, clinical course, laboratory parameters, and urinary protein analysis were investigated at admission (baseline, t₀), 3-5 days (t_3-5), 10-17 days (t_10-17), and after 1 year of follow-up (t₃₆₅). Results: Of the 34 patients (male/female ratio: 23/11; age: 41 ± 14 years) included in the study, 4 underwent hemodialysis (HD). Glomerular filtration rate was 17 ± 14 mL/min at t₀ and increased to 27 ± 26 mL/min (t_3-5), 57 ± 20 mL/min (t_10-17), and 84 ± 16 mL/min (t₃₆₅). Albuminuria and tubular proteinuria (α₁-and β₂-microglobulin) decreased during follow-up; the urinary α₁-microglobulin concentration in patients who required HD was significantly higher than that in patients not requiring HD (t₀: 186 ± 51 vs. 45 ± 26 mg/g creatinine; t_3-5: 87 ± 14 vs. 32 ± 16 mg/g creatinine; t_10-17: 63 ± 18 vs. 28 ± 12 mg/g creatinine; p < 0.001). Conclusions: DOBV infection of inpatients in Northern Germany is associated with severe kidney injury that recovers within a few weeks and normalizes within 1 year. Tubular proteinuria is associated with the severity of kidney injury and the necessity of renal replacement therapy in these DOBV-infected patients.