Korean J Clin Microbiol.  2010 Mar;13(1):7-13. 10.5145/KJCM.2010.13.1.7.

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

• Yoon YK
• Sim HS
• Kim JY
• Park DW
• Sohn JW
• Chun BC
• Kim MJ

• KMID: 1828589
• DOI: http://doi.org/10.5145/KJCM.2010.13.1.7

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.

Keyword

Hepatitis A; Acute kidney injury; C-reactive protein; Genotype

MeSH Terms

Acute Kidney Injury
Adult
Amino Acid Substitution
C-Reactive Protein
Case-Control Studies
Genetic Variation
Genotype
Hepatitis
Hepatitis A
Hepatitis A virus
Humans
Korea
Multivariate Analysis
RNA
Sequence Analysis
Seroepidemiologic Studies
C-Reactive Protein
RNA

Figure

• 

  Fig. 1. The phylogenetic tree constructed for the nucleotide sequences of VP1 region of hepatitis A virus genome. The tree includes 66 strains isolated from this study and the reference strains. ∗The strains isolated from the non-fulminant hepatitis with acute kidney injury. †The strains isolated from the fulminant hepatitis. ‡The reference strains.

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