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Am J Kidney Dis. 2014 Sep;64(3):452-6. doi: 10.1053/j.ajkd.2014.04.030. Epub 2014 Jun 20.

Hantavirus infection with severe proteinuria and podocyte foot-process effacement.

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Department of Nephrology, University Hospital, Freiburg, Germany.
Department of Nephrology, University Hospital, Freiburg, Germany; Institute of Pathology, University Hospital Hamburg-Eppendorf, Germany.
Department of Nephrology, University Hospital, Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Albert-Ludwigs-University Freiburg, Germany.
Department of Pathology, University Hospital, Basel, Switzerland.
Department of Nephrology, University Hospital, Freiburg, Germany. Electronic address:


Nephropathia epidemica, a zoonosis caused by Hantavirus infection (most commonly subtype Puumala) is associated with flu-like symptoms and acute kidney failure. Kidney manifestations are characterized predominantly by tubulointerstitial nephritis, hemorrhage into medullary tissues, interstitial edema, and tubular cell necrosis. Kidney failure is accompanied by proteinuria, and in some cases, nephrotic-range proteinuria may occur. However, the cellular mechanisms of proteinuria remain to be elucidated. We describe a Hantavirus (Puumala) infection in a 27-year-old man with acute kidney failure and severe and rapidly reversible proteinuria. Light microscopy of a kidney biopsy specimen showed only minor changes of glomeruli. However, transmission electron microscopy revealed podocyte foot-process effacement. Immunofluorescence staining of the slit diaphragm protein podocin and the tight junction protein ZO-1 revealed a partial mislocalization of these proteins. Together, these findings highlight that Hantavirus infection may perturb podocyte integrity, resulting in glomerular proteinuria. These alterations of podocytes and consequently the glomerular filtration barrier may be transient and resolve within weeks.


Hantavirus infection; acute kidney failure; podocyte foot-process effacement; proteinuria

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