Hantavirus Infections with Renal Involvement do not Result in Chronic Renal Disease or End-stage Renal Failure

Rodent-borne hantavirus infections are one of the most important causes worldwide of acute kidney injury in previously healthy, mostly young adults, but remain still heavily underestimated as such by the global nephrological community. Despite of a sometimes severe impairment of renal function, often accompanied by massive proteinuria, this acute zoonotic affection has, after survival, an excellent renal and general prognosis on short and on long term. However, this fact remains contradicted by repeated and unproven statements of the opposite in literature. Indeed, with the advent of early hantavirus research in the ‘80’s, speculations rose as to the potential of this novel agent to cause chronic renal disease, and even end-stage renal failure, since the bulk of pathogenic hantaviruses has the human kidney as main target organ.

In several sections of this review, the authors try to dismantle point by point these unjustified assumptions. Finally, they show that in two recent Finnish retrospective studies on a local form of hantaviral acute kidney injury, nor the degree of acute renal impairment, nor the degree of acute but transient proteinuria, had any negative impact on the good renal outcome. These two studies, including the most important cohort numbers so far for the two specific questions, confirm an increasing series of case-reports or clinical overviews of hantavirus infections, all showing a good renal prognosis.

The generally somber prognosis for acute kidney injury during hospitalization, as expressed in numerous publications based on Kidney Disease: Improving Global Outcomes (KDIGO), should be reviewed for the peculiar case of hantavirus infections.