Papadimitriou MG
Hantavirus nephropathy

Kidney Int (Sep) 49:887-902 1995

Hantavirus infection is an important and endemic cause of acute renal failure in certain regions of the world. The virus is transmitted by aerosolization of rat droppings, the main natural host of these organisms. Acute infection in humans is now well recognized as a cause of hemorrhagic fever with renal syndrome (HFRS), the latter being expressed in a highly variable fashion, ranging from mild renal impairment to severe oliguric renal failure with shock and disseminated intravascular coagulation. In its most severe form hantavirus infection is associated with widespread vascular dysfunction, shock and renal shutdown. In this review Dr. Papadimitriou discusses the history, clinical picture, immunology, management and prophylactic measures for Hantavirus nephropathy. The prevalence of clinical and laboratory findings and prognosis in patients with various types of HFRS caused by different strains of Hantaan viruses is presented in detail. In addition, the global distribution of various strains and their relative virulence with regard to renal manifestations are discussed. Hypothetical mechanisms of Hantavirus induced renal disease and clinical shock as well as immune-mediated mechanisms of vascular injury are described

Dr. Papadimitriou is joined by a group of distinguished experts on Hantavirus nephropathy from around the world. The discussants provide additional insights into the molecular biology, pathogenesis and management of this disease. Most intriguing however, is a discussion of the possible role of these viruses in the pathogenesis of chronic progressive renal failure. Data from a Baltimore study are described where serologic evidence of Seoul Hantavirus infection was found in patients with hypertensive renal disease. One idea is that chronic viral infection might lead to immune reaction to the virus with healing and subsequent progressive renal disease. This new hypothesis is most interesting and definitely worth your time. (Toto)

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ARF etiology : Acute glomerulonephritis/RPGN
Proteinuria/Hematuria : Other systemic infections