Hemorrhagic Fever With Renal Failure Syndrome Follow-up

  • Author: Rajendra Bhimma, MB, ChB, MD, DCH (SA), FCP (Paeds)(SA), MMed (Natal); Chief Editor: Craig B Langman, MD   more...
 
Updated: May 7, 2010
 

Further Inpatient Care

Patients with hemorrhagic fever with renal failure syndrome (HFRS) who have established oliguric renal failure must be carefully monitored for water, electrolyte, and acid-base imbalance, which must be promptly corrected. Vasoactive agents should be used in patients with shock after correction of volume deficit. In cases with pulmonary edema, the use of forced diuresis by administration of furosemide, vigorous ultrafiltration, or continuous arteriovenous hemofiltration can be lifesaving.

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Further Outpatient Care

Recovery takes 0-3 months from the acute phase of the illness, usually beginning in the middle of the second week. The diuretic phase may last from a few days to weeks, and close monitoring for electrolyte imbalances and signs of dehydration is needed. Patient education regarding electrolyte imbalances and signs of dehydration is imperative. Follow-up care is needed as often as warranted.

The convalescent phase lasts for 3-6 months. Glomerular clearances usually normalize, and the concentration ability of the renal tubules steadily improves. Follow-up should be conducted on a weekly basis, until the clearance normalizes, and then on a monthly basis.

Long-term follow-up care is important, especially because hypertension and proteinuria have been reported on long-term follow-up.

Patients with hypertension, residual neurologic defects, concentration defects in the renal tubules, or persistent proteinuria should be followed on a regular basis.

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Transfer

Early referral to a tertiary center is essential to prevent complications and decrease morbidity and mortality.

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Deterrence/Prevention

Human habits can increase incidence of the disease; hence, basic preventive measures are required, including the following:

  • Proper storing of food and avoiding contamination by rats
  • Taking precautions during work or travel in farms contaminated with rodents
  • Avoiding camping in grain fields
  • Avoiding stocking straw stacks outside houses
  • Avoiding sleeping outside homes
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Complications

Complications that develop during the illness are rare.

  • Abdominal pain and back pain occurs because of retroperitoneal hemorrhage.
  • During the oliguric or early diuretic phase, renal rupture occurs, but it responds to conservative management and only occasionally requires surgical intervention.
  • Pulmonary edema and intraventricular hemorrhage occur.
  • Transient hypopituitarism occurs, causing an abnormal anterior pituitary hormonal response and leading to delayed diuresis and the late appearance of Sheehan syndrome. Atrophy of the anterior pituitary lobe with diminution of gland function may occur during the late stages of the disease.[6]
  • Hemorrhagic fever with renal failure syndrome is a self-limiting disease, and most patients recover without any sequelae; however, in few patients, neurologic and renal tubular defects may persist.
    • Defective sodium reabsorption is observed to occur in patients one year after the illness, causing increased sodium excretion.
    • Long-term monitoring of proteinuria and hypertension is essential.
  • Some patients may develop hypercalciuria and hyperphosphaturia due to tubular defects.
  • Although recovery from hantaviral disease is complete, chronic renal insufficiency and hypertensive renal disease have been reported.
  • Approximately 10% of adults with end-stage renal disease (ESRD) have Hantavirus-specific antibodies.
  • The Dobrava virus causes severe form of hemorrhagic fever with renal failure syndrome in Balkan regions of eastern Europe. It is associated with an increased mortality rate; patients develop hepatomegaly, with dysfunction observed more commonly than hemorrhagic manifestations.
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Patient Education

The prevalence of the disease largely depends on human habits; therefore, patient health education is essential to prevent the disease.

Educate patients regarding the following issues:

  • Avoidance of living in barracks and sleeping in open areas outside homes
  • Eradication of rodents
  • Effective storage of food items
  • Early reporting of illness and obtaining medical advise
  • Avoidance of person-to-person transmission or nosocomial transmission
  • Need for a liberal intake of fluid during the diuretic phase of the illness to avoid dehydration and shock

For additional advice or information regarding the disease, patients are advised to contact the Centers for Disease Control and Prevention (CDC) (Tel: 800-CDC-INFO, email: cdcinfo@cdc.gov).

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Contributor Information and Disclosures
Author

Rajendra Bhimma, MB, ChB, MD, DCH (SA), FCP (Paeds)(SA), MMed (Natal)  Associate Professor of Pediatrics, Principal Specialist, Department of Pediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

Rajendra Bhimma, MB, ChB, MD, DCH (SA), FCP (Paeds)(SA), MMed (Natal) is a member of the following medical societies: American Association for the Advancement of Science, International Pediatric Transplant Association, International Society of Nephrology, South African Medical Association, South African Paediatric Association, and South African Transplant Society

Disclosure: Nothing to disclose.

Coauthor(s)

Vellore K Sairam, MBBS  Assistant Professor, Department of Nephrology, Sri Ramachandra Medical College and Research Institute, India

Disclosure: Nothing to disclose.

Luther Travis, MD  William W Glauser Professor of Pediatrics and Pediatric Nephrology, Department of Pediatrics, Divisions of Nephrology and Diabetes, University of Texas Medical Branch and Children's Hospital

Luther Travis, MD is a member of the following medical societies: Alpha Omega Alpha, American Federation for Medical Research, International Society of Nephrology, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Deogracias Pena, MD  Medical Director of Dialysis, Department of Pediatrics, Cook Children's Medical Center; Clinical Associate Professor, Texas Tech University School of Medicine

Deogracias Pena, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and American Society of Pediatric Nephrology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Frederick J Kaskel, MD, PhD  Director of the Division and Training Program in Pediatric Nephrology, Vice Chair, Department of Pediatrics, Montefiore Medical Center and Albert Einstein School of Medicine

Frederick J Kaskel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Physiological Society, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, Eastern Society for Pediatric Research, Federation of American Societies for Experimental Biology, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Renal Physicians Association, Sigma Xi, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Howard Trachtman, MD  Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine

Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD  The Isaac A Abt, MD, Professor of Kidney Diseases, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago

Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology

Disclosure: Amgen Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None; Raptor Pharmaceuticals, Inc Grant/research funds None; Alexion Pharmaceuticals, Inc. Grant/research funds None

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Distribution of Hantavirus pulmonary syndrome cases in the United States by virus type. Courtesy of the Centers for Disease Control and Prevention.
 
 
 
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