• Esther C de Weerd, Caroline E Douma, and Hanke W Wattel-Louis.
• Spaarne Ziekenhuis, afd. Interne Geneeskunde, Hoofddorp.
• Ned Tijdschr Geneeskd. 2015 Jan 1;159:A8273.

AbstractAlthough unusual in the Netherlands, acute kidney injury is sometimes caused by infection with Hantavirus, a zoonosis transmitted by rodents. Hantavirus infections can cause a syndrome known as 'haemorrhagic fever with renal syndrome', characterized by fever, acute kidney injury and thrombocytopenia. Recovery is spontaneous and treatment is mostly supportive. We describe two cases of otherwise healthy men presenting with fever and acute kidney injury. Laboratory tests revealed raised inflammatory parameters and thrombocytopenia. Urine analysis revealed proteinuria, microscopic haematuria and cell casts. Despite treatment with fluids, renal function declined and oliguria and fluid retention developed in one patient. Dialysis could be avoided, with spontaneous recovery of renal function in both cases. Serological testing revealed acute Hantavirus infection. Acute kidney injury caused by Hantavirus infections is rare in the Netherlands, but should be suspected in any patient presenting with renal failure and a history of viral infection.

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