Cystatin C and alpha-1-Microglobulin Predict Severe Acute Kidney Injury in Patients with Hemorrhagic Fever with Renal Syndrome

Magnus J Hansson*, Rasmus Gustafsson, Chloé Jacquet , Nedia Chebaane, Simon C Satchell, Therese Thunberg, Clas Ahlm, Anne-Marie Fors Connolly

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

14 Citations (Scopus)
44 Downloads (Pure)


Puumala orthohantavirus causes hemorrhagic fever with renal syndrome (HFRS) characterized by acute kidney injury (AKI), an abrupt decrease in renal function. Creatinine is routinely used to detect and quantify AKI; however early AKI may not be reflected in increased creatinine levels. Therefore, kidney injury markers that can predict AKI are needed. The potential of the kidney injury markers urea, cystatin C, α1-microglobulin (A1M) and neutrophil gelatinase-associated lipocalin (NGAL) to detect early AKI during HFRS, was studied by quantifying the levels of these markers in consecutively obtained plasma (P) and urine samples (U) for 44 HFRS patients. P-cystatin C and U-A1M levels were significantly increased during early HFRS compared to follow up. In a receiver operating characteristic (ROC) curve analysis, P-cystatin C, U-A1M and P-urea predicted severe AKI with area under the curve 0.72, 0.73 and 0.71, respectively, whereas the traditional kidney injury biomarkers creatinine and U-albumin did not predict AKI. Nearly half of the HFRS patients (41%) fulfilled the criteria for shrunken pore syndrome, which was associated with the level of inflammation as measured by P-CRP. P-cystatin C and U-A1M are more sensitive and earlier markers compared to creatinine in predicting kidney injury during HFRS.
Original languageEnglish
Article number666
Number of pages14
Issue number8
Publication statusPublished - 18 Aug 2020

Structured keywords

  • Bristol Heart Institute


  • Acute kidney injury
  • hemorrhagic fever with renal syndrome
  • Orthohantavirus
  • Puumala virus
  • viral hemorrhagic fever
  • Cystatin C, α-1-microglobulin
  • neutrophil gelatinase-associated lipocalin
  • creatinine


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