Hemorrhagic fever with renal syndrome in Albania. Focus on predictors of acute kidney injury in HFRS

•Hemorrhagic Fever with Renal syndrome is a zoonosis caused by member of family Bunyaviriade, genus Hantavirus.•Dobrava strain was the viral agent causing hemorrhagic fever with renal syndrome in Albania.•The infection was associated with a high mortality rate of 9%.•Nadir platelet count and hyponatremia were identified as independent predictors for acute kidney injury.

BackgroundHemorrhagic fever with renal syndrome (HFRS) is a rodent borne zoonosis, caused by the members of the family Bunyaviridae, genus Hantavirus. The main clinical features of the infection by this virus family are fever, thrombocytopenia and acute kidney injury.ObjectiveThe aim of our study was to identify, for the first time, characteristic features of HFRS in the Albanian population.Study designThe study comprised 33 consecutive patients admitted with suspected HFRS from April 2011-April 2016 at one center. Clinical diagnosis was confirmed by ELISA and real-time PCR. Statistical analysis was performed to identify prognostic markers and indicators of disease severity.ResultsThe virus strain causing HFRS was Dobrava type in all 33 cases. The disease outbreaks occurred during the period June-July. Mean hospital stay was 15.7 ± 6.9 days. 29 (88%) of the patients were male. The mean age was 39.7 ± 14.1. 16 (48.5%) patients were from Northeast Albania. 8 (24.2%) patients required dialysis. The strongest correlation was the inverse relationship of nadir platelet count with urea and creatinine, p < 0.0001, p < 0.0079 respectively. Creatinine and hyponatremia were inversely correlated p = 0.0007, whereas hyponatremia and nadir platelet count had the highest sensitivity and specificity for development of severe AKI, 92.6%, 100%; 88.9%, 83.3% respectively. Mortality rate was 9.09%.ConclusionHFRS is a severe viral disease in Albania caused by Dobrava strain. It is associated with high mortality, 9.09% in our cohort. In our study, thrombocytopenia, urinary volume, hyponatremia were indicators of more severe disease.