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.     

肾综合征出血热病毒对肾小管上皮细胞聚集状态的影响

目的　观察人胚肾小管上皮细胞 (RTC)受肾综合征出血热病毒 (HFRSV)感染后粘附聚集状态的改变和精氨酸 甘氨酸 天门冬氨酸序列 (Arg Gly Asp ,RGD)对这一改变的影响。方法　应用HFRSV感染体外培养的RTC ,采用原位分子杂交技术检测RTC内的HFRSV并用流式细胞仪(FACS)及血细胞计数仪观察比较正常组、感染组及感染后加RGD组细胞聚集状态的差别。结果　(1)FACS结果 :受HFRSV感染的RTC聚集性较正常组明显减弱 ,RGD能使感染组的聚集性进一步减弱。 (2 )血细胞计数仪计数结果 :正常组细胞悬液随时间延长聚集性逐渐增强 ,而感染组的聚集性则无明显变化 ,两组间有显著性差异。RGD组与感染组相比聚集性有减弱趋势 ,但统计学无差异。结论　HFRSV可能通过改变RTC的细胞骨架结构、使RTC脱落来参与肾综合征出血热 (HFRS)急性肾功能衰竭 (ARF)的发病 ;RGD能够影响受HFRSV感染后RTC的聚集状态 ,提示了RGD在肾综合征出血热ARF中的潜在治疗作用。     

肾综合征出血热患者多种免疫促炎因子及抗炎因子变化及其作用

目的探讨肾综合征出血热（HFRS）患者急性期（包括发热期、低血压休克期、少尿期）与恢复期促炎因子和抗炎因子的变化及其作用。 方法检测2016年4月至2017年6月哈尔滨医科大学第四附属医院和黑龙江省农垦红兴隆管理局中心医院收治的30例确诊为HFRS急性期和恢复期患者血清中肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）、白细胞介素-6（IL-6）和抗炎因子转化生长因子-β1（TGF-β1）、白细胞介素-10（IL-10）的水平,同期检测患者的胱抑素C（Cys-C）、肌酐（Cr）、乳酸脱氢酶（LDH）以及部分凝血活酶时间（APTT）等指标。另选同期13名健康志愿者作对照组,检测TNF-α、IFN-γ、IL-6、TGF-β1和IL-10水平。应用SAS 9.3国际标准统计学编程软件对结果进行分析。 结果HFRS患者急性期IFN-γ（χ²= 4.273、P= 0.0336）、TNF-α（χ²= 16.3562、P < 0.0001）、IL-6（χ²= 9.752、P = 0.0018）和IL-10（χ²= 6.3352、P= 0.0118）水平均显著高于对照组,差异均有统计学意义。HFRS患者急性期TGF-β1水平显著低于对照组,差异有统计学意义（χ²= 7.822、P= 0.0056）。HFRS患者恢复期TGF-β1水平与对照组接近或略低,差异无统计学意义（χ²= 3.000、P = 0.0833）。HFRS患者发病不同时期Cys-C、Cr、LDH和APTT等指标均于急性期升高,于恢复期下降,与IFN-γ、TNF-α、IL-6和IL-10变化趋势一致。 结论HFRS急性期时IFN-γ、TNF-α和IL-6等促炎因子分泌增加,主要因CD4⁺CD25⁺FoxP3 Treg细胞（调节性T细胞）产生的抗炎因子TGF-β1分泌不足,细胞因子失衡是导致机体免疫病理损伤的重要机制。     

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。     

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.     

连续性肾脏替代疗法治疗危重型肾综合征出血热的疗效观察

目的 观察连续性肾脏替代疗法(CRRT)在抢救危重型肾综合征出血(HFRS)患者的临床疗效.方法 收集2008年2月至2011年10月本院收治的危重型HFRS患者40例,随机分成CRRT组(20例)和普通血液透析(HD)组(20例),两组性别、年龄及肾功能均具有可比性.采用回顾性分析的方法,分别观察两组患者治疗前后肾功能、临床疗效、并发症及预后.结果 与HD组相比,CRRT组患者治愈和好转率均显著提高(P< 0.05).结论 应用CRRT治疗危重型肾综合征出血热患者,可明显改善患者的临床症状并降低病死率.     

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.     

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.     

Differential diagnosis of hemorrhagic fever with renal syndrome and acute surgical diseases of abdominal organs

The results of differential diagnosis of hemorrhage fever with renal syndrome and acute surgical diseases of abdominal organs in 1250 patients were analyzed. It was revealed that the course of the disease was similar to acute abdomen in 13.2% of them. The combination of fibrogastroduodenoscopy and diagnostic laparoscopy is optimal for differential diagnosis and permits to reveal typical symptoms of hemorrhage fever with renal syndrome.     

Pulmonary-renal syndrome due to hemorrhagic fever with renal syndrome: an unusual manifestation of puumala virus infection in France

The authors report about a patient who presented with acute respiratory failure, bilateral alveolar infiltrates, without signs of fluid overload, and acute renal failure. Percutaneous renal biopsy revealed acute interstitial nephritis with medulla hemorrhages. Serologic tests for Puumala virus infection were positive. Hemorrhagic fever with renal syndrome should be considered when patients present with pulmonary-renal syndrome.     

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.     

Hemorrhagic fever with renal syndrome

Based on the observation of 11 patients (10 males and 1 female), the occurrence of hemorrhagic fever with renal syndrome in two new geographic areas of Romania is reported. Two patients died within several hours after admission. The other nine recovered gradually. In four patients hemodialysis was necessary. A complete recovery of renal functions one year after onset could be proved in four patients. The clinical, laboratory, morphopathological (necroptic and bioptic), epidemiologic and evolutive characteristics of the disease, especially the main features supporting the diagmosis of hemorrhagic fever with renal syndrome, are discussed.     

早期应用连续性血液净化治疗危重型肾病综合征出血热的临床分析

目的探讨连续性血液净化（continuous blood purification,CBP）在危重型肾病综合征出血热（hemorrhagic fever with renal syndrome,HFRS）的临床治疗效果。方法回顾分析解放军第三医院肾脏内科近2年收治的24例危重型HFRS患者在治疗原发病的基础上,均给予CBP治疗,采用连续性静脉一静脉血液滤过（continuous veno-venous hemofiltration,CVVH）或连续性静脉一静脉血液透析滤过（continuous veno-venous hemodiafiltration,CVVHDF）,持续治疗时间不少于24h。比较患者治疗前后血白细胞（WBC）、血小板（PLT）,动脉血气分析、二氧化碳结合力（C02CP）,C反应蛋白（CRP）,血尿素氮（BUN）、血肌酐（SCr）、血清丙氨酸氨基转氨酶（ALT）、天冬氨酸氨基转氨酶（AST）、部分活化凝血活酶时间（APTT）的变化。结果24例危重型HFRS患者经CBP治疗后12～48h的PLT、动脉血气pH值、C02CP显著提高（P〈0．05）,WBC、CRP、BUN、SCr、ALT、AST、部分活化凝血活酶时间降低（P〈0．01）。结论对于危重型HFRS患者给予早期积极CBP干预治疗可稳定血流动力学、迅速改善内皮细胞功能紊乱的全身炎症状态,为补液、营养支持及后续的药物治疗创造条件,能获得满意疗效。