MP264A PREDICTIVE MODEL FOR SUCCESSFUL CONVERSION OF CONTINUOUS RENAL REPLACEMENT THERAPY TO INTERMITTENT HEMODIALYSIS IN CRITICALLY ILL PATIENTS

Abstract

INTRODUCTION AND AIMS: Acute kidney injury can be caused by infection with Hantavirus, a zoonosis transmitted by rodents. Even though this is rare in Europe, it should be considered in differential diagnosis of acute renal failure. The aim of this study was to analyse the characteristics and outcome of patients diagnosed with Hantavirus infection in our centre. METHOD(S): A retrospective analysis of medical records of patients with a positive test for Hantavirus infection between 2010 and 2016 was performed. The antibodies against hantavirus were detected by commercially available ELISA kit (Euroimmun, Medizinische Labordiagnostik AG, Luebeck, Germany). RESULT(S): We examined a total of 59 patients with clinically considered Hantavirus infection, out of whom 10 (17%) were positive (6x IgM positive, 1x IgM and IgG positive, 3x IgG positive only but with clinically appropriate symptoms), one of the patients was excluded from further analyses due to concomitant ANCA-associated vasculitis. Five of 9 patients were men (56%), the median age was 50 (range 24-75 years), infection was diagnosed during all year so there is no relation between contagion and season. In total 4 patients (44%) required hemodialysis at entry (2-7 dialysis procedures were performed), median serum creatinine in non-dialysed ones was 345 mumol/L (range 87-533), 4/9 patients were oligo-anuric, 7/9 patients had distinct erythrocyturia, 8/9 patients had leukocyturia, proteinuria was usually negative or only mild, 3/9 (33%) patients underwent renal biopsy with acute tubular necrosis found in 2. Median peak CRP was 108 mg/L. Except one all the others developed anemia, 6/9 had thrombocytopenia. Six of 9 patients had potential signs of extrarenal involvement - the most frequent was internal bleeding and only one patient had eye involment - acute glaucoma. During the infection 6/9 patients required ICU care, 7/9 received antibiotics and 5/9 patients received corticosteroids. All patients survived the acute infection, at 3 months 7/9 patients had normal or near-normal renal function, the remaining two had CKD stage 3. CONCLUSION(S): Hantavirus infection in Europe was associated with quite a severe disease course in most patients but the outcome was very good and none of the patients required long-term dialysis. Although rare, Hantavirus infection should be considered as a potential cause of acute kidney injury, especially if there is history of fever and cause is not completely clear.