Renal involvement with hantavirus infection (hemorrhagic fever with renal syndrome)

INTRODUCTION

Infection with a hantavirus may lead to life threatening pulmonary and renal disease [1-6]. In 1993, a highly fatal epidemic due to acute hantavirus infection in the American Southwest was associated with the rapid onset of respiratory failure, renal insufficiency, and fever [7].

The members of the Hantavirus genus (eg, Hantaan, Puumala, Seoul, Dobrava, Sin Nombre, and Andes virus) each produce different forms of clinical disease in humans. As an example, renal disease due to Puumala virus is relatively mild and is associated with a benign long-term prognosis [8,9]. Sin Nombre virus is the hantavirus found most frequently in the United States, which primarily induces a cardiopulmonary syndrome, as does the Andes virus found in South America [10]. More severe renal disease can occur with infections by Hantaan and Dobrava virus [6,11].

Clinical syndromes caused by hantaviruses have also been known as epidemic hemorrhagic fever, hemorrhagic nephrosonephritis, Songo fever, Korean hemorrhagic fever, and nephropathia epidemica. In an attempt to avoid confusion, these diseases are now collectively referred to by the World Health Organization as "hemorrhagic fever with renal syndrome" (HFRS) [1,12].

Renal disease associated with hantavirus infection will be reviewed here. The epidemiology and diagnosis of hantavirus infections, and hantavirus associated cardiopulmonary syndrome, are discussed elsewhere. (See "Epidemiology and diagnosis of hantavirus infections" and "Hantavirus cardiopulmonary syndrome".)

EPIDEMIOLOGY

Hantavirus infection is acquired by inhalation of aerosolized virus containing particles, or contact with urine, secretions or feces of infected rodents. Smoking, possibly by altering the conditions of the human airways, is a risk factor for Puumala virus infection [13,14]. The rodent vectors differ for each viral species but include mice, voles, shrews, and rats. Person-to-person transmission has been reported in Andes virus infection [15].