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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2017  |  Volume : 28  |  Issue : 5  |  Page : 1206-1208
Renal failure due to important arbovirus infection: A short summary

1 Wiwanitkit House, Bangkhae, Bangkok, Thailand
2 Public Health Curriculum, Surindra Rajabhat University, Surin, Thailand; Department of Tropical Medicine, Hainan Medical University, Haikou, China; Department of Community Medicine, Dr. D. Y. Patil University, Maharashtra, India; Department of Medicine, Faculty of Medicine, University of Nis, Nis, Serbia; Department of Biological Science, Joseph Ayobabalola University, Ilara-Mokin, Nigeria

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Date of Web Publication21-Sep-2017

How to cite this article:
Wiwanitkit S, Wiwanitkit V. Renal failure due to important arbovirus infection: A short summary. Saudi J Kidney Dis Transpl 2017;28:1206-8

How to cite this URL:
Wiwanitkit S, Wiwanitkit V. Renal failure due to important arbovirus infection: A short summary. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Jun 17];28:1206-8. Available from: http://www.sjkdt.org/text.asp?2017/28/5/1206/215124

To the Editor,

Arbovirus infection at present has emerged as a major public health problem around the world. Due to the expanding habitat of mosquitoes due to global warming, the chance the mosquito vectors existing in increasing numbers has become a big public health concern. In addition, due to the increase in various transportation systems, the disease migration, mosquito transfer, and movement of disease carriers to other places are already reported worldwide. The existence of the tropical arbovirus infection in nontropical world has currently become a major issue in medicine.[1]

Arbovirus disease has become the new emerging disease in several countries around the world. In general, arbovirus infection can result in acute febrile illness and can also cause several complications including renal involvement. The renal problems due to arbovirus infection are an important topic in nephrology. Nevertheless, a nephrologist in nontropical countries might not well recognize the renal problem in a fresh arbovirus infection. In fact, renal failure can be an important clinical presentation of arbovirus infection. In this short article, the author summarizes the current information available on renal failure due to important arbovirus infections (dengue, chikungunya, Japanese encephalitis, yellow fever, and Zika virus infections).

Dengue is an important mosquito-borne arbovirus infection. It is common in tropical areas around the world. The classical presentation of dengue is that of an acute febrile illness associated with hemorrhagic complications. The basic findings of hemoconcentration, atypical lymphocytosis, and thrombocytopenia are usually the classical hallmark findings for clinical diagnosis.[2] In dengue, the early diagnosis and prompt management by fluid replacement therapy is necessary. In patients with dengue, the renal problem can occur due to the hypovolemic effect due to extravascular fluid leakage during the course of dengue, or it can be immune complex mediated.[3] Vachvanichsanong et al noted that “kidney involvement is not actually that rare but is underrecognized and often only reported when microscopic hematuria, proteinuria, electrolyte imbalance, or even AKI is found.”[4] Vakrani and Subramanyam noted that acute renal failure was more common in case with severe dengue (dengue hemorrhagic fever or dengue shock syn-drome).[5] In addition, Wiwanitkit found that most of death cases with dengue usually have renal failure.[6] It is clear that the early management of renal problem detected in dengue patients can result in favorable outcome.[4] Since the dengue patients with acute renal failure who required dialysis treatment usually end up with death, the early diagnosis is highly warranted.[7] In cases with acute renal failure, institution of early peritoneal dialysis can be an effective management that can result in complete recovery of the patients.[2],[4] However, the big problem in clinical practice is the lack of awareness about renal involvement among dengue patients, and most practitioners focus only on hematological problems without giving due concern for occult renal problem in the patients. Furthermore, lack of good clinical practice guidelines for case management is an important concern that requires international consensus.[8] In addition to the reports on renal failure due to dengue, there are also some interesting reports on dengue in the patients with underlying renal failure and cases of postrenal transplantation.[9],[10]

Chikungunya virus infection is another common arbovirus infection. This infection is similar to dengue, but it has a significant high rate of joint problems. The patients usually have the arthropathy and acute febrile illness. For renal problem, there are a few reports on renal problem due to chikungunya virus infection. Although it is extremely rare, acute renal failure due to chikungunya virus has been reported.[11]

Japanese encephalitis is also an arbovirus infection. Since pig is an important amplifying host for Japanese encephalitis, the high prevalence of this disease is observed in the areas with pig farming. The classical problem of Japanese encephalitis is acute febrile illness accompanied with encephalitis. The disease can result in deadly neurological sequelae. Regarding the renal problem in Japanese encephalitis, there is no clear evidence or clinical report that Japanese encephalitis can induce renal failure. There is an effective vaccine for the prevention of Japanese encephalitis. In endemic areas, the Japanese encephalitis vaccination is recommended for the patients undergoing dialysis.[12]

Yellow fever is an arbovirus infection seen in tropical Africa and South America. Severe jaundice is the main clinical problem due to this infection. Similar to Japanese encephalitis, there is an effective vaccine against yellow fever. For the renal problem due to yellow fever, there is no evidence that yellow fever can result in renal failure. Nevertheless, there is an interesting observation of renal failure as postyellow fever vaccination complication.[13]

Zika virus is another newly emerging problematic arbovirus infection. At present, the spread of Zika virus becomes a global public health problem. The important problem is the transplacental vertical transmission of the virus that can result in congenital neurological problems. In adult, most cases are asymptomatic.[14] Nevertheless, since this is a new problem, there are still only very little data on the clinical problems of this infection. Focusing on renal involvement due to Zika virus infection, there are only limited data on this issue.[15] Alcendor recently proposed that kidney could be an important reservoir site for the Zika virus.[16] There are a few reports showing the clinical data on renal function study in cases with Zika virus infection. In the case report from China, the renal function test during the course of illness in the index patient was within normal limits.[16] Finally, there is another interesting report on complete remission of renal problem in a case with nephrotic syndrome after recovery from Zika virus infection.[17] The exact physiological interrelationship on this observation requires further study for clarification.

Renal failure due to arbovirus infection is an important problem in nephrology that the general practitioner should be aware of. When the practitioner manages a case with arbovirus infection, monitoring of renal function is absolutely necessary. In case that a kidney problem including to renal failure is identified, prompt management is suggested.

Conflict of interest: None declared.

   References Top

Patterson J, Sammon M, Garg M. Dengue, Zika and Chikungunya: Emerging arboviruses in the New World. West J Emerg Med 2016; 17:671-9.  Back to cited text no. 1
Wiwanitkit V. Immune complex: Does it have a role in pathogenesis of renal failure in dengue infection? Ren Fail 2005;27:803-4.  Back to cited text no. 2
Wiwanitkit V. Immune complex: Does it have a role in pathogenesis of renal failure in dengue infection? Ren Fail 2005;27:803-4.  Back to cited text no. 3
Vachvanichsanong P, Thisyakorn U, Thisyakorn C. Dengue hemorrhagic fever and the kidney. Arch Virol 2016;161:771-8.  Back to cited text no. 4
Vakrani GP, Subramanyam NT. Acute renal failure in dengue infection. J Clin Diagn Res 2017;11:OC10-3.  Back to cited text no. 5
Wiwanitkit V. Acute renal failure in the fatal cases of dengue hemorrhagic fever, a summary in Thai death cases. Ren Fail 2005;27:647.  Back to cited text no. 6
Goonasekera CD, Thenuwara BG, Kumarasiri RP. Peritoneal dialysis in dengue shock syndrome may be detrimental. J Trop Med 2012;2012:917947.  Back to cited text no. 7
Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH, Jummaat F. Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): A comparative analysis. Postgrad Med J 2016;92:78-86.  Back to cited text no. 8
Tangnararatchakit K, Tirapanich W, Tapaneya-Olarn W, et al. Severe nonfebrile dengue infection in an adolescent after postoperative kidney transplantation: A case report. Transplant Proc 2012;44:303-6.  Back to cited text no. 9
Maia SH, Brasil IR, Esmeraldo Rde M, Ponte CN, Costa RC, Lira RA. Severe dengue in the early postoperative period after kidney transplantation: Two case reports from Hospital Geral de Fortaleza. Rev Soc Bras Med Trop 2015;48:783-5.  Back to cited text no. 10
Rajapakse S, Rodrigo C, Rajapakse A. Atypical manifestations of chikungunya infection. Trans R Soc Trop Med Hyg 2010; 104:89-96.  Back to cited text no. 11
Nakamura Y, Matsubara H, Yoshioka S, et al. Antibody response following Japanese encephalitis vaccination in patients undergoing maintenance hemodialysis. Nihon Jinzo Gakkai Shi 1985;27:839-44.  Back to cited text no. 12
Vasconcelos PF, Luna EJ, Galler R, et al. Serious adverse events associated with yellow fever 17DD vaccine in Brazil: A report of two cases. Lancet 2001;358:91-7.  Back to cited text no. 13
Wiwanitkit S, Wiwanitkit V. Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: Don’t miss it! Asian Pac J Trop Med 2016;9:513.  Back to cited text no. 14
Deng Y, Zeng L, Bao W, Xu P, Zhong G. Experience of integrated traditional Chinese and Western medicine in first case of imported Zika virus disease in China. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2016;28:106-9.  Back to cited text no. 15
Alcendor DJ. Zika virus infection of the human glomerular cells: Implications for viral reservoirs and renal pathogenesis. J Infect Dis 2017. doi: 10.1093/infdis/jix171. [Epub ahead of print]  Back to cited text no. 16
Peralta-Aros C, García-Nieto V. Does Zika virus infection induce prolonged remissions in children with idiopathic nephrotic syndrome? Pediatr Nephrol 2017;32:897-900.  Back to cited text no. 17

Correspondence Address:
Somsri Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok
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