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Urine soluble urokinase‐type plasminogen activator receptor levels correlate with proteinuria in P uumala hantavirus infection
Author(s) -
Outinen T. K.,
Mäkelä S.,
Huttunen R.,
Mäenpää N.,
Libraty D.,
Vaheri A.,
Mustonen J.,
Aittoniemi J.
Publication year - 2014
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12257
Subject(s) - hantavirus , medicine , proteinuria , plasminogen activator , urine , urokinase , immunology , receptor , virology , kidney , virus
Objectives Urokinase‐type plasminogen activator receptor (u PAR ) is upregulated during inflammation and known to bind to β 3 ‐integrins, receptors used by pathogenic hantaviruses to enter endothelial cells. It has been proposed that soluble u PAR (su PAR ) is a circulating factor that causes focal segmental glomerulosclerosis and proteinuria by activating β 3 ‐integrin in kidney podocytes. Proteinuria is also a characteristic feature of hantavirus infections. The aim of this study was to evaluate the relation between urine su PAR levels and disease severity in acute Puumala hantavirus ( PUUV ) infection. Design A single‐centre, prospective cohort study. Subjects and methods Urinary su PAR levels were measured twice during the acute phase and once during convalescence in 36 patients with serologically confirmed PUUV infection. Fractional excretion of su PAR ( FE su PAR ) and of albumin ( FE alb) was calculated. Results The FE su PAR was significantly elevated during the acute phase of PUUV infection compared to the convalescent phase (median 3.2%, range 0.8–52.0%, vs. median 1.9%, range 1.0–5.8%, P = 0.005). Maximum FE su PAR was correlated markedly with maximum FE alb ( r = 0.812, P < 0.001) and with several other variables that reflect disease severity. There was a positive correlation with the length of hospitalization ( r = 0.455, P = 0.009) and maximum plasma creatinine level ( r = 0.780, P < 0.001) and an inverse correlation with minimum urinary output ( r = −0.411, P = 0.030). There was no correlation between FE su PAR and plasma su PAR ( r = 0.180, P = 0.324). Conclusion Urinary su PAR is markedly increased during acute PUUV infection and is correlated with proteinuria. High urine su PAR level may reflect local production of su PAR in the kidney during the acute infection.