Beyond the Kidneys: Pulmonary-Renal Involvement in Hantavirus Infection - A 10-Year Experience

Background Hantaviruses are rodent-borne pathogens that cause hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. Increasing evidence suggests clinical overlap between renal and pulmonary involvement, yet data on their coexistence in hospitalized patients remain limited. Materials and Methods We retrospectively analyzed 20 patients with serologically confirmed hantavirus infection admitted to the University Hospital of Nephrology, Skopje, from 2013 to 2023. Demographic, clinical, and laboratory data were collected and compared between patients with and without pulmonary involvement on hospital days 1, 3, and 7. Results Of the patients, 19 (95%) were male, aged 14-66 years (mean 36), and predominantly from rural areas. Most infections occurred during spring-summer. The mean interval from symptom onset to admission was 6.4 days. Gastrointestinal symptoms and fever were present in 88%, followed by edema, cough, and conjunctival suffusion. All patients presented with thrombocytopenia and AKI, and 77% required hemodialysis. Pulmonary involvement occurred in 35% of patients. Compared with patients without pulmonary disease, those with pulmonary involvement had higher day-1 C-reactive protein (CRP), alkaline phosphatase, and D-dimer; higher day-3 lymphocytes, CRP, and lactate dehydrogenase; and lower platelet counts on days 1 and 3. Conversely, creatinine (day 1), alanine aminotransferase and potassium (day 3), and hemoglobin and calcium (day 7) were higher in patients without pulmonary involvement. Mean hospitalization was longer in patients with pulmonary disease (12.8 vs. 7.4 days, p =0.020). Conclusion Hantavirus infection often affects both renal and pulmonary systems, with pulmonary involvement linked to slower renal recovery, prolonged hospitalization, and worse outcomes.