Clinical Characterization of Hepatitis A Infection Complicated with Acute Kidney Injury and Sequence Analysis of the VP1 Region / 대한임상미생물학회지

ABSTRACT

BACKGROUND: Recently hepatitis A virus (HAV) infection has propagated among adults in Korea due to the epidemiologic shift in the age-specific HAV seroprevalence. There are apparently increase in symptomatic patients with severe diseases. This study aimed to investigate clinical and molecular characteristics related to acute kidney injury (AKI) occurrence in HAV infection. METHODS: A case-control study was conducted in a university hospital between February 2009 and July 2009. Clinical findings of non-fulminant HAV infection complicated with AKI (N=5) were compared to those without AKI (N=60). The complete sequence of the VP1 region (900 bp) was amplified from stool specimens by the RT-PCR to determine HAV genotypes and genetic variations between the two groups. RESULTS: Among 65 patients with non-fulminant HAV infections, 5 patients (7.7%) developed AKI. In multivariate analyses, higher level of C-reactive protein was independently associated with AKI occurrence in non-fulminant HAV infections [odds ratios=1.094, 95% confidence interval=1.011-1.183]. HAV RNA was detected in 57 (86.4%) patients 53 strains (93.0%) showed genotype IIIA and 4 strains presented genotype IA. All HAV isolates from the AKI patients belonged to the genotype IIIA and shared the identical sequences with those from the non-AKI patients. CONCLUSION: This study indicates that higher level of C-reactive protein is associated with AKI occurrence in non-fulminant HAV infections. There were no specific nucleotide or amino acid substitutions in the VP1 region associated with AKI occurrence.