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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2008  |  Volume : 19  |  Issue : 2  |  Page : 250-253
Hemorrhagic Fever with Acute Renal Failure: A Report from Kosova


Department of Nephrology and Haemodialysis, University Clinical Centre of Kosova, Prishtina, Kosova, Serbia

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   Abstract 

Acute renal failure (ARF) is a well-known complication of hemorrhagic fever (HF). We studied patients with HF and ARF who were treated in our department for two years between March 2005 and the end of December 2006. The age of the patients ranged from 17 to 71 years. The incidence of complications in the study patients was acceptable and similar to that reported in the literature of Balkan region. Our study shows that the efficacy of the overall results in the treatment of these patients in our center is comparable to the published data in the country from the Balkan region.

Keywords: Hemorrhagic fever, Acute Renal failure, Hemodialysis, Kosova

How to cite this article:
Zylfiu BI, Elezi Y, Bajraktari G, Rudhani I, Abazi M, Kryeziu E. Hemorrhagic Fever with Acute Renal Failure: A Report from Kosova. Saudi J Kidney Dis Transpl 2008;19:250-3

How to cite this URL:
Zylfiu BI, Elezi Y, Bajraktari G, Rudhani I, Abazi M, Kryeziu E. Hemorrhagic Fever with Acute Renal Failure: A Report from Kosova. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Aug 4];19:250-3. Available from: http://www.sjkdt.org/text.asp?2008/19/2/250/39040

   Introduction Top


Bleeding and acute renal failure (ARF) are well-recognized complications in patients with hemorrhagic fever (HF). It has been described by many authors; the serious cases were seen during the Korean War (1951-53) when more than 3000 American and Korean soldiers fell severely ill with infection in association with ARF, generalized bleeding and shock. The causative agent was first isolated 1976 from the lungs of the striped field mouse Apodemus agrarius, and designated Hantaan virus. [1] Further studies revealed another antigenetically related virus (Puumala_PUU), which was isolated from the bank vole (Clethrionomys glareolus). [2] In the Balkan region of the former Yugoslavia, such epidemic outbreaks have been recorded since the early 1950s. In Kosova, during and after the 1999 war, more than 100 patients with HF were hospitalized in the infectious diseases wards and some, who had associated ARF were, managed in the Department of Nephrology and hemo­dialysis. [3]

The pathophysiology of ARF in HF is not known, but seems to be multifactorial. Renal failure first occurs after days or weeks of illness with HF. Although immunological factors are clearly involved, such as vasculitis other non-immunological factors such as disseminated intravascular coagulation (DIC), renal ischemia and metabolic disorders may play a role in the causation of ARF. Once diagnosed, the treatment for patients with HF and ARF should commence as early as possible.


   Material and Methods Top


We undertook a retrospective study of records from the Nephrology and Hemo­dialysis Department in the UCCK in Prishtina, Kosova during the period between March 2005 and the end of December 2006. Data collected included detailed clinical history and physical examination, biochemical tests, and ultrasonic examination. All patients with HF and ARF were analyzed in detail.


   Results and Discussion Top


During the two years of study, a total of 192 patients were treated for ARF, all of whom required hemodialysis. The age of the patients ranged from 17 to 71 years. Of them, 20 patients had HF. Some demographic details of the study patients are given in [Table - 1]. The commonest cause of ARF in our series was polytrauma with HF ranking second, followed by malignancy [Table - 2], [Figure - 1].

Acute renal failure in patients with HF is a very frequent medical emergency in Kosova, particularly in Malisheva municipality: this is particularly so during the summer months when a large number of patients get infected with the hanta virus. [4],[5],[6],[7] In year 2005, of the 90 patients with ARF seen in our series, 12 (10.8 %) had HF. Four of them typically presented with all clinical manifestations; high fever, general bleeding, hematomas, hematuria, gastrointestinal hemorrhage, sub­conjuctival hemorrhage metabolic distur­bances such as acidosis, hyperkalemia, high blood urea nitrogen (BUN) and raised serum creatinine. All four needed to be started on hemodialysis within six hours of admission. Two patients died after a few hours, six patients received 5-10 sessions of hemo­dialysis following which they recovered. In the year 2006, we had eight patients (16%) with HF and ARF. All of them needed treatment with hemodialysis. One of them died after a few hours while the other patients recovered.


   Conclusion Top


Renal dysfunction after HF is a problem in our country. Nephrologists should play an active role in the care and research in these patients. Improvements in renal risk assessment, monitoring and preventive measures are needed in patients with HF to avoid morbidity and mortality.

 
   References Top

1.Lee HW, Lee PW. Korean hemorrhagic fever: Demonstration of causative antigen and antibodies. Korean J Med 1976;19:371-83.  Back to cited text no. 1    
2.Brumer-Konvenkonito M, Vaheri A, Hovi T, et al. Nephropathia epidemica detection of antigen in bank valkes and saerological diagnosis of human infections. J Infect Dis 1980;141:131-4.  Back to cited text no. 2    
3.Dennis H, Conrad ME. Accelerated intra­vascular coagulation in a patient with Korean hemorrhagic fever. Arch Intern Med 1968; 121:149-52.  Back to cited text no. 3    
4.Gligic A, Dimkovic, N, Xiao SY, et al. Belgrade virus new hantavirus causing severe hemorrhagic fever with renal syndrome in Yugoslavia. J Infect Dis 1992;166:113-20.  Back to cited text no. 4    
5.Skataric V, Dimitrijevic J, Jovanovic D, Marie M, Kovacevic Z, Gligic A. Clinical features of hemorrhagic fever with renal syndrome Epidemic in Yugoslavia 1996, The Fourth International Conference of HFRS 8 hanta virus, Atlanta; 1998.  Back to cited text no. 5    
6.Hukic M, Kunt A, Torstenson S, Lundkrist A, Wiger D, Niklosson BV. Hemorrhagic fever with renal syndrome in northern Bosnia. Lancet 1996;347:56-7.  Back to cited text no. 6    
7.Antoniadis A, Stylianakis A, Papa A, Alexian-Daniel S, Lampropoules A, Nichol ST. Direct genetic detection of Dobrava virus in Greek and Albanian patients with renal syndrome. J Infect Dis 1996;174:407-10.  Back to cited text no. 7    

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Correspondence Address:
Bejtush Ibrahim Zylfiu
Department of Nephrology and Haemodialysis, University Clinical Centre of Kosova, Prishtina, Kosova, Serbia

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PMID: 18310878

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