Hemorrhagic Fever With Renal Failure Syndrome Treatment & Management

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

Medical Care

Treatment depends on the stage of the disease and on the patient's hydration status and hemodynamic condition. The most essential step in managing hemorrhagic fever with renal failure syndrome (HFRS) is maintaining the patient's circulatory and hemodynamic status.

During active illness, maintaining fluid and electrolyte balance is mandatory. Early and effective fluid therapy is the cornerstone of managing renal failure. Most patients recover with supportive care. The indications for various medications are based on the patient's specific requirements during the different stages of the disease process.

The use of vasoactive agents and intravenous albumin during periods of shock is helpful. Excessive administration of fluids can lead to extravasation caused by capillary leak, especially during the febrile and hypotensive stages.

Consider the use of diuretics, such as furosemide, when the patient has volume overload and oliguria. Consider renal replacement therapy if the patient has no response to diuretics and if he or she has other features, such as fluid overload, hyperkalemia, and acidosis that increases azotemia and is associated with oliguria or anuria.

The possibility of the sudden appearance of life-threatening GI bleeding is always present. In that case, blood transfusions and the use of H2 receptor antagonists are indicated as general emergency procedures. In the case of disseminated intravascular coagulation (DIC), fresh plasma infusions, plasma exchange treatment, or both are administered but are not always effective.

Results of one prospective placebo-controlled trial suggested that intravenous ribavirin decreased the severity and mortality of hemorrhagic fever with renal failure syndrome in China.[5] In contrast, 30 patients with Hantavirus pulmonary syndrome (HPS) who received investigational open-label intravenous ribavirin tolerated it well. Furthermore, treatment was accompanied by drug-induced anemia, which required transfusion, and no clear evidence of benefit was obtained. Differences in dosing schedules did not account for the contrasting responses, and the rapidity with which the disease progressed may have cause the lack of response in the patients with HPS.

Ribavirin is not approved for intravenous use in the United States, pending further ongoing studies. If ribavirin is used during the early part (febrile phase) of the illness, it reduces viremia and the severity of the illness.

Antihypertensives are indicated in patients with hypertension, which is usually present during the oliguric phase of the illness.

Dialysis is indicated if the patient has prolonged oliguria with no response to medical treatment and if renal failure is rapid deteriorating with worsening fluid and electrolyte abnormalities.

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Surgical Care

If the clinical presentation involves extravasation of plasma in the abdomen (suggestive of acute abdomen and subsequent development of paralytic ileus), the patient probably needs surgical evaluation and, occasionally, exploratory laparotomy. Renal rupture, which rarely occurs, requires surgical management.

A pediatric nephrologist should perform renal biopsy, if indicated, after taking all precautions. The patient's hemodynamic status and coagulation status should be stable before the biopsy is performed.

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Consultations

Consultation with the following specialists are indicated as needed:

  • Pediatric nephrologist
  • Pediatric infectious disease specialist
  • Pediatric critical care specialist
  • Pediatric surgeon
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Diet

A low-sodium diet with restriction of fluid during the oliguric phase, followed by liberal intake of fluid in the diuretic phase, is recommended.

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Activity

Bed rest during the acute phase of the illness is recommended.

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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

References

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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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