肾综合征出血热病毒对肾小管上皮细胞损伤的研究

目的 研究肾综合征出血热病毒（ＨＦＲＳＶ）对肾小管上皮细胞（ＲＴＣ）的致病作用。方法 应用ＨＦＲＳＶ感染体外培养的人胚ＲＴＣ（ＨＦＲＴＣ）,采用原位分子杂交技术检测ＨＦＲＴＣ内的ＨＦＲＳＶ并作台盼蓝染色、透射电镜（ＴＥＭ）观察。结果 （１）ＨＦＲＳＶ能够直接感染培养的ＨＦＲＴＣ;（２）从第７天起被感染的ＨＦＲＴＣ死亡明显高于对照组;（３）ＴＥＭ观察表明ＨＦＲＳＶ可致ＨＦＲＴＣ的细胞膜、细胞器损害。     

Dengue in renal transplant patients: a retrospective analysis

We reviewed the impact of dengue in 27 renal transplant recipients (9 females and 18 males) at a mean of 63 (6-287) months after transplantation. Their mean age was 37+/-14 years and all were first transplantations (21 live donors, 6 deceased donors). Twenty-six were dengue fever cases and one had dengue hemorrhagic fever. Symptoms were: fever (100%), muscular pain (90%), malaise (75%), and headache (68%). Eight (29%) patients were admitted to hospital with one death. All other cases had full recovery. Mean serum creatinine before dengue was 1.4+/-0.6 mg/dL, increased to a mean peak of 1.9+/-1.2 mg/dL (P<0.001), and returned to baseline after recovery (1.6+/-0.82 mg/dL, P=NS). After a mean follow-up of 39+/-18 months, four patients lost their grafts due to chronic allograft nephropathy and four died, due to infectious causes not related to dengue. The first episode of dengue in transplanted patients resembled a flu-like syndrome, as in the general population. It did not cause long-term damage to either the patient or the graft.     

The pathogenesis of the renal syndrome in hemorrhagic fever]

Lipid peroxidation was investigated in 89 patients suffering from hemorrhagic fever with renal syndrome. In addition to routine tests, measurements were made of plasma malonic dialdehyde and acyl hydroperoxides the levels of which were found increased 1.3-1.4-fold and 1.5-2-fold, respectively, in the severe disease compared to control values. The degree of lipid peroxidation intensification and aggravation of the symptoms proved to agree. It is suggested that abnormal lipid peroxidation contributes to development of renal syndrome which in hemorrhagic fever may progress to acute renal failure.     

60例儿童肾综合征出血热患者的临床特点及重型高危影响因素

目的分析儿童肾综合征出血热（HFRS）的临床特点及重型病例的危险因素,以指导该病的早识别、早诊断和早治疗。 方法选取200年1月至2016年12月西安市儿童医院临床诊断的儿童肾综合征出血热患儿共60例,分析其临床资料特点,并采用多因素Logistic回归分析明确重型病例的危险因素。 结果入组60例患儿临床表现均有发热,且消化道症状发生率高,肾综合征出血热的"三红"、"三痛"典型表现发生率并不高。实验室指标检查显示：入组患儿白蛋白异常、尿蛋白异常、降钙素原、白细胞及血小板计数异常率较高。多因素Logistic回归分析结果显示,PLT < 30 × 10⁹/L（χ² = 34.75、P < 0.001）、ALT > 500 U/L（χ² = 27.30、P < 0.001）、PCT > 25 ng/ml（χ² = 8.45、P = 0.02）、尿蛋白阳性（χ² = 11.32、P < 0.001）和Scr > 250 μmol/L（χ² = 7.89、P < 0.001）共5个影响因素的回归系数与病情严重程度相关,均具有统计学意义。 结论儿童肾综合征出血热临床表现不典型,无特异性表现,容易漏诊误诊,临床医师应该提高警惕;PLT、ALT、PCT、Scr显著异常及尿蛋白阳性是重型HFRS的危险因素。     

Is there an increased long-term risk of hypertension and renal impairment after Puumala virus-induced nephropathy?

Nephropathia epidemica (NE) is a mild form of hemorrhagic fever with renal syndrome, assumed to have a favorable prognosis. NE patients who manifested a higher glomerular filtration rate and mean systolic blood pressure, and more proteinuria, versus controls at 5 years of follow-up demonstrated no major abnormalities after 10 years. Antihypertensive treatment was, however, more common. Could NE predispose some patients to develop hypertension after all?     

Spontaneous rupture of the kidneys in hemorrhagic fever with renal syndrome

During the recent 5 years we had 29 patients with hemorrhagic fever and renal syndrome complicated by a spontaneous kidney rupture. This complication occurred during an anuric period in 18 patients and within the first 24 hours of restored diuresis in 11 patients. Major clinical presentations of the kidney rupture were deterioration of lumbar and abdominal pains, meteorism and symptoms of an internal bleeding. Palpation revealed hematoma at the site of the ruptured kidney, tension of the anterior abdominal wall and symptomatic peritoneal irritation. Diagnosis of spontaneous kidney rupture in hemorrhagic fever with the renal syndrome (HFRS) relies on clinical, laboratory and ultrasound studies. Additional studies are plain urography and retroperitoneal diagnostic puncture of the affected site. Conservative therapy was given to 11 patients with erythrocyte counts of 3 x 10(12)/l or higher. The treatment was operative in 18 patients. Indications for surgery were progressive anemia, a palpable retroperitoneal hematoma and symptomatic peritoneal irritation. All patients underwent evacuation of blood clots and ligation of the renal ruptures. In the authors' opinion, renal decapsulation and pyelostomy are useful in this condition. Bilateral involvement and severe renal failure are contraindications for nephrectomy in HFRS. It may be used only as a last resort in life-threatening bleeding.     

The participation of histamine and serotonin in the genesis of acute kidney failure in patients with hemorrhagic fever with renal syndrome

In order to explore possible involvement of histamine and serotonin in acute renal failure related to hemorrhagic fever with renal syndrome (HFRS), selected markers or renal lesions have been compared with biochemical findings in highly severe cases. Literature reports and the study results lead the authors to conclude that histamine and serotonin are obviously pathogenetic determinants of HFRS since their concentrations in plasma of these patients are increased 3-fold. It is suggested that the biologically active substances may be a link between renal disease and hyperergy in severe and critical disease forms.     

Changes of lactate dehydrogenase and its isoenzyme activity in renal diseases.

Analysis of the five different serum isoenzymes of lactate dehydrogenase (LDH) is of great value in the differential diagnosis of various diseases. In order to investigate the changes of serum LDH isoenzymes in several renal diseases, 44 patients with Korean hemorrhagic fever, 10 patients with chronic renal failure, 10 patients with nephrotic syndrome, and 15 healthy subjects were studied. The isoenzymes of LDH were determined by the Helena LDH isoenzyme electrophoresis procedure. LDH1 was 22.3 +/- 2.8, LDH2 29.4 +/- 5.1, LDH3 20.8 +/- 4.5, LDH4 9.0 +/- 2.7 and LDH5 8.8 +/- 3.2 mU/ml in healthy subjects. In patients in the oliguric stage of Korean hemorrhagic fever, LDH1 was 63.4 +/- 28.5, LDH2 99.7 +/- 40.7, LDH3 107.5 +/- 39.0, LDH4 41.9 +/- 32.8 and LDH5 37.2 +/- 26.3 mU/ml, while LDH1 was 23.8 +/- 11.7, LDH2 38.9 +/- 14.6, LDH3 36.0 +/- 18.7, LDH4 13.8 +/- 13.0 and LDH5 12.7 +/- 7.6 mU/ml in nonoliguric patients. In patients with chronic renal failure LDH1 was 33.2 +/- 10.8, LDH2 41.9 +/- 13.3, LDH3 27.7 +/- 8.5, LDH4 12.1 +/- 6.2 and LDH5 12.3 +/- 5.8 mU/ml. In patients with nephrotic syndrome, LDH1 was 25.1 +/- 4.3, LDH2 33.5 +/- 4.9, LDH3 23.1 +/- 6.2, LDH4 8.4 +/- 3.7 and LDH5 8.4 +/- 3.4 mU/ml. In summary, LDH3 activity was elevated in the oliguric stage of Korean hemorrhagic fever and LDH2 was elevated in chronic renal failure; those values were correlated with the BUN level.     

Hemorrhagic fever with renal syndrome in an endemic area of Greece.

From 1983 to 1990, 32 patients with hemorrhagic fever with renal syndrome (HFRS) were admitted to our hospital. The diagnosis was confirmed by high IgM type titers of antibodies to Hantaan virus. All patients presented with serum and urine abnormalities suggesting renal involvement. Serum creatinine was elevated and ranged between 1.8 and 14.3 mg/dl. Proteinuria ranged between 0.5 and 6.4 g/24 h. Seven patients died due to shock or hemorrhage, while 6 patients were supported by hemodialysis or peritoneal dialysis. Five of them had a complete recovery. Two patients were discharged with some degree of renal impairment which remained stable 12-15 months later. Kidney biopsy in the first patient performed 1 year after his discharge revealed some degree of interstitial fibrosis and tubular atrophy as well as an area with ischemic and sclerosed glomeruli. We conclude that HFRS in Greece is a severe disease with a high mortality rate. The disease may cause chronic renal failure in a limited number of patients.     

Acute pancreatitis associated with hemorrhagic fever with renal syndrome: clinical analysis of 12 cases

Abstract

Background: Acute pancreatitis is one of the rare complications of hemorrhagic fever with renal syndrome (HFRS), which easy to be misdiagnosed as acute abdomen, usually critically ill, poor treatment effect, highly mortality. In this study, we retrospectively analyzed to explore the clinical characteristics, 12 cases of hemorrhagic fever with renal syndrome complicated with acute pancreatitis treatment methods and prognosis. Methods: We conducted a retrospective study of HFRS in patients complicated with acute pancreatitis. 12 cases were collected from Ningbo first hospital between January 2001 and December 2012. Clinical information and laboratory parameters were obtained by reviewing literature and records. Results: Twelve from 156 cases (7.69%) HFRS complicated with acute pancreatitis. Men comprised more than half (75%) of the sample population, the mean age was (38?±?19) years. Abdominal pain was the main clinical manifestations in all the patients, all of their serum amylase and serum lipase were increased, 10 patients were given the total abdomen CT examination, eight cases showed enlargement of the pancreas and surrounding leakage, two cases showed pancreatic necrosis and hemorrhage. Three cases complicated with pulmonary edema. In 12 cases, four of them received hemodialysis treatment, one gives surgical intervention. Eight cases were complete remission, three cases were partial remission and one case was death. Conclusions: Acute pancreatitis is one of rare of the serious complications of HFRS, whereas the correct diagnosis and clear the cause of disease is critical for improve the quality of life of patients and reduce the mortality, timely hemodialysis treatment is effective, early intervention can improve the prognosis.     

济南市传染病医院1997～2006年肾综合征出血热2164例分析

目的 探索近年来城市中心传染病医院肾综合征出血热(HFRS)病例特点,为进一步制定防治策略和采取有效措施提供依据.方法 收集济南市传染病医院1997～2006年10年间住院确诊HFRS患者的流行病学资料和近5年(2002～2006)住院HFRS患者的临床资料,建立数据库,应用SPSS 13.0软件进行统计分析.结果 2164例HFRS患者,年龄为1～82岁,平均37.97岁,20～49岁占70.19%,男女比例3∶ 1,农村患者占78.51%,多数患者生活或工作环境中有鼠类活动;发病率逐年下降,未愈/病死率似有下降趋势;发病形式以全年散发为主,春季稍多.临床特点是不典型病例较多,重危患者较多,并发症和继发症复杂.多器官功能衰竭、急性呼吸窘迫综合征、急性肾功能衰竭、颅内出血、DIC是主要死因.结论 HFRS仍然是危害人们健康的重要疾病,必须持续灭鼠、杀螨、防护重点人群,积极开展新的实验室诊断方法的研究,提高基层医疗机构诊断水平,加强城市中心传染病医院治疗研究.     

Hantavirus nephropathy

Pathogenic rodent-borne hantaviruses cause in humans generalized infections that involve the peripheral vascular bed and severely affect their permeability. We describe a 30-yr-old male patient with clinical symptoms characterizing five conventional phases of hemorrhagic fever with renal syndrome after an uncommonly severe hantavirus infection with the Puumala strain. Renal biopsy in this situation typically demonstrates acute hemorrhagic interstitial nephritis, particularly pronounced in the outer medulla. Hantaviruses are not cytopathic for most cells, and their interactions with endothelial cells that activate immune mechanisms play a key role in the pathogenesis of vascular dysfunction characterizing this disease.     

Clinical characteristics of haemorrhagic fever with renal syndrome in children

From January 1988 to September 1989, seven patients (4 girls and 3 boys, aged 3–12 years) with haemorrhagic fever with renal syndrome (HFRS) were hospitalised at the University Children's Hospital in Belgrade. In four patients the disease appeared as a family outbreak, the others were sporadic cases. In six patients the clinical presentation was suggestive of HFRS, as they had fever with headache, myalgia, sore throat and gastrointestinal illness followed by renal abnormalities. However, severe haemorrhagic syndrome with petechia, haematoma, haematemesis and melaena was present in one patient only. Renal disease presented as nephritic syndrome and/or acute renal failure. Five patients recovered after 2–3 weeks without sequellae, one patient had decreased renal function 17 months after the start of the disease and the remaining patient died. In six patients the diagnosis of HFRS was confirmed serologically by a significant rise in antibody titres against hantaviruses, while in the patient with the fatal and fulminant course of the disease, the diagnosis was established on the basis of epidemiological and autopsy findings. We suggest that children living in endemic areas who develop an ill-defined, febrile and gastrointestinal disease with renal dysfunction should be evaluated for HFRS.     

Belgrade and Hantaan hantaviruses — the causative agents of severe haemorrhagic fever with renal syndrome in children in Serbia

During an outbreak of haemorrhagic fever with renal syndrome (HFRS) in 1989, five children (3 girls, 2 boys, aged 6.8–16 years) with a severe form of the disease were treated; four of these were followed for 22–28 months. The main clinical features in all five patients were: fever, headache, myalgia, abdominal and back pain and vomiting; haemorrhagic syndrome was present in four children. Renal syndrome presented with severe acute renal failure in all five patients. All patients recovered. Serological confirmation by an indirect immunofluorescence assay, by enzyme immunoassay for IgM antibodies and by plaque reduction neutralization test showed infection by Belgrade virus in three and by Hantaan virus in two patients. It was not possible to differentiate these two serogroups on the basis of clinical features. This study provides futher information on the circulation of different hantaviruses causing severe HFRS in Serbia.     

Severe hemorrhagic complications from infection with nephropathia epidemica strain of Hantavirus.

In the following we describe a case of severe hemorrhagic fever with renal syndrome (HFRS) caused by Puumala infection. The diagnosis was made by immunofluorescence technique and by solid phase enzyme immunoassay using recombinant nucleocapsid antigen of a Puumala serotype strain. Such a clinical course with severe bleeding complications is considered untypical for Puumala induced HFRS.     

Lung 99mTc DTPA transfer in renal disease and pulmonary infection

The half-time of transfer of 99mTc DTPA (T50) is a useful method of assessing lung epithelial permeability, which has been shown to be altered in patients with acquired immunodeficiency syndrome (AIDS) who have Pneumocystis carinii pneumonia (PCP). The present study was designed to assess the usefulness of the T50 measurement in evaluating patients with renal transplants, breathlessness, and fever. An assessment was also made of the effect of renal failure on the T50 result. Sixty-eight non-smokers (12 normal subjects, ten patients with chronic renal failure not requiring dialysis (CRF), ten patients on haemodialysis (HD), ten patients on chronic ambulatory peritoneal dialysis (CAPD), 13 patients with functioning renal transplants (Tx), seven transplanted patients with PCP, two transplanted patients with cytomegalovirus pneumonia, and four transplanted patients with other lung infections), and 30 smokers (ten normal subjects, five CRF, five HD, five CAPD, five Tx) were studied. The lung epithelial permeability of the patients with renal failure, as judged by the whole lung T50, was not significantly different from that of the normal subjects. The T50 of transplanted smokers was significantly longer than that of the normal subjects who smoked and not significantly different from the transplanted non-smokers. Patients with PCP and CMV pneumonitis had significantly faster T50 values compared with all other patients with renal disease. This fast T50 suggests that the test may be of use in identifying patients who have an alveolitis as a cause for their fever when immunosuppressed following a renal transplant.     

Electrolyte excretion in patients with a history of hemorrhagic fever with renal syndrome

Renal transportation of sodium and potassium was studied in 85 patients who sustained hemorrhagic fever complicated with renal syndrome (HFRS). The examinees were given routine diet No. 7 recommended by Pevzner. The conclusions were made on the analysis of circadian excretion and clearance of electrolytes studied and the levels of their water-load-induced tubular transportation: distal and proximal reabsorption and distal excretion of sodium, the correlation between potassium secretion and reabsorption in the distal part of the nephron. It was revealed that within the first year after the disease onset, 37.5 per cent of patients had increased levels of sodium excretion as part of the salt-loss syndrome developed due to decreased sodium reabsorption in the distal part of the nephron. Later the status was featured by moderately pronounced disorders of distal sodium reabsorption in 6.25 per cent of the patients only, mostly in those with HFRS-induced pyelonephritis. Increased excretion of potassium noted in the first months after HFRS only was the result of an increase in sodium excretion. The aforementioned disorders could be easily compensated by a routine diet and therefore a decrease in the levels of sodium or potassium avoided.     

Acute Tubular Necrosis Associated with Non-Hemorrhagic Dengue Fever: A Case Report

Dengue fever (DF) is an arthropod-born viral infection affecting humans. Dengue viruses are transmitted through the bites of the mosquito Aedes aegypti. Acute renal failure (ARF) is reported in patients who are affected mainly with Dengue hemorrhagic fever (DHF), which is a severe presentation of the disease. We report the case of a 24-year-old Omani female with no past history of particular medical problems. She was referred to our hospital for the further management of acute renal failure. She had clinical features of DF without DHF. The kidney biopsy showed features of acute tubular necrosis (ATN). She had a complete recovery after 25 days and required three sessions of hemodialysis. We conclude that DF even without DHF may lead to ATN and ARF. Clinicians should be aware of this etiology. Treatment is supportive and may require dialysis. The prognosis could be favorable.     

Renal amyloidosis followed more than 5 years: report of 12 cases

Renal involvement with amyloidosis is common but causes patient survival to be poor, rarely reaching 5 years. In this study, we retrospectively reviewed clinical and biological characteristics as well as treatments and outcomes of patients with renal amyloidosis followed for more than 5 years. Between 1975 and 2003, 485 patients were diagnosed with renal amyloidosis including only 12 patients who were followed more than 5 years. The six men and six women of mean age 42.4 years (range 18 to 66 years) displayed renal signs of lower limb edema in all cases; hypertension in four cases, proteinuria on urinalysis in all cases with microscopic hematuria in five cases. Biological tests showed nephrotic syndrome in 11 patients, normal renal function in nine patients, and renal failure in three patients whose mean creatinine was 481.6 micromol/L (range 294 to 726). The amyloidosis was AA type in 11 cases and non-AA in one case. An etiologic survey revealed spondylarthropathy in one patient, pulmonary tuberculosis in two patients, chronic bronchitis in three patients, hepatic hydatic cyst in one patient, Mediterranean familial fever in two patients, Crohn's disease in one patient, Hodgkin's lymphoma in one patient, and multiple myeloma in one patient. Specific treatment was initiated with colchicine in seven patients. At a 110-month mean follow-up (range 53 to 153 months), remission of nephrotic syndrome was observed in four cases, progression to chronic renal failure in two patients, and to end-stage renal failure in five cases (range 53 to 196 months), with stabilization of renal function in seven patients. In conclusion, primary amyloid disease should be optimally suppressed in patients with renal involvement. The role of this treatment in remission of renal amyloidosis is not well established. This efficacy of the treatment has been demonstrated in some patients with improved survival.     

The effect of hemodialysis on the vasopressin level and on the renin-aldosterone system in patients with hemorrhagic fever with renal syndrome

A total of 29 patients with severe hemorrhagic fever associated with the renal syndrome were studied for impact of extracorporeal hemodialysis on the activity of the renin-aldosterone system (RAS), plasma vasopressin and osmolality and the levels of the major osmotically active agents, as well as the circadian urine output and blood pressures. In patients with oliguria there was a significant activation of RAS, an increase in plasma vasopressin ad osmolality due to the increment of the urea in presence of hyponatremia. Hemodialysis led to a temporary normalization of plasma aldosterone and vasopressin levels and a decrease in blood pressure. No significant changes were documented in the activity of the plasma renin and circadian urinary output. A direct correlation was established between the plasma osmolality and the levels of vasopressin. In patients with polyuria developed in presence of hypernatremic hyperosmia plasma vasopressin elevated and aldosterone dropped.