• Joerg Latus, Matthias Schwab, Evelina Tacconelli, Friedrich-Michael Pieper, Daniel Wegener, Bianka Rettenmaier, Andrea Schwab, Larissa Hoffmann, Juergen Dippon, Simon Müller, Peter Fritz, David Zakim, Stephan Segerer, Daniel Kitterer, Martin Kimmel, Karl Gußmann, Martin Priwitzer, Barbara Mezger, Birgit Walter-Frank, Angela Corea, Albrecht Wiedenmann, Stefan Brockmann, Christoph Pöhlmann, M Dominik Alscher, and Niko Braun.
• Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
• Nephrol. Dial. Transplant. 2015 Feb 1; 30 (2): 245-51.

BackgroundPuumala virus (PUUV) is the most common species of hantavirus in Central Europe. Nephropathia epidemica (NE), caused by PUUV, is characterized by acute kidney injury (AKI) and thrombocytopenia. The major goals of this study were to provide a clear clinical phenotyping of AKI in patients with NE and to develop an easy prediction rule to identify patients, who are at lower risk to develop severe AKI.MethodsA cross-sectional prospective survey of 456 adult patients with serologically confirmed NE was performed. Data were collected from medical records and prospectively at follow-up visit. Severe AKI was defined by standard criteria according to the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) classification. Fuller statistical models were developed and validated to estimate the probability for severe AKI.ResultsDuring acute NE, 88% of the patients had AKI according to the RILFE criteria during acute NE. A risk index score for severe AKI was derived by using three independent risk factors in patients with normal kidney function at time of diagnosis: thrombocytopenia [two points; odds ratios (OR): 3.77; 95% confidence intervals (CI): 1.82, 8.03], elevated C-reactive protein levels (one point; OR: 3.02; 95% CI: 1.42, 6.58) and proteinuria (one point; OR: 3.92; 95% CI: 1.33, 13.35). On the basis of a point score of one or two, the probability of severe AKI was 0.18 and 0.28 with an area under the curve of 0.71.ConclusionThis clinical prediction rule provides a novel and diagnostically accurate strategy for the potential prevention and improved management of kidney complications in patients with NE and, ultimately, for a possible decrease in unnecessary hospitalization in a high number of patients.© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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