Hemorrhagic Fever With Renal Failure Syndrome Workup

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

Laboratory Studies

The geographic distribution of hemorrhagic fever with renal failure syndrome (HFRS), an exposure to rodents, the patient's clinical picture, and the laboratory data suggest the diagnosis.

  • Enzyme-linked immunosorbent assay (ELISA) is useful in detecting antihantaviral-specific immunoglobulin M (IgM) early in the course of the illness.
  • Antihantaviral immunoglobulin G (IgG) titers may be elevated for prolonged periods (as long as 10 y).
  • Blood findings usually reveals clinically significant leukocytosis, an elevated or normal hematocrit level, and thrombocytopenia.
  • Elevated levels of liver enzymes, BUN, and serum creatinine can be observed.
  • Hyponatremia, hyperphosphatemia, and hyperkalemia may occur during the oliguric phase.
  • Complement (C3) levels may be decreased; therefore, hemorrhagic fever with renal failure syndrome should be included in the differential diagnosis of hypocomplementemic acute nephritic syndrome.
  • The coagulation profile can be altered with a prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT), or bleeding time. levels of fibrin-degradation products may also be elevated.
  • Urinalysis consistently shows hematuria and proteinuria. Proteinuria may last for few years after the attack.
  • Increased levels of nitric oxide (NO) during the acute phase of the hemorrhagic fever with renal failure syndrome illness are correlated with disease activity.
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Imaging Studies

No specific radiologic studies are indicated.

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Other Tests

Hantavirus antigen can be detected in various tissues, predominately in the microvasculature, by using immunohistochemical (IHC) methods (eg, immunohistochemistry analysis for the Hantavirus antigen in lung and tubular cells). Polymerase chain reaction is also indicated to assess for Hantavirus.

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Procedures

Performing a kidney biopsy is not essential for diagnosis. As discussed above, the diagnosis of hemorrhagic fever with renal failure syndrome is based on a history of exposure to infected rodents, clinical symptoms and signs, and laboratory findings. If the diagnosis cannot be clearly made during the course of the illness and if the patient's hemodynamic and coagulation status is stable, a renal biopsy is indicated.

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Histologic Findings

Upon histologic evaluation, renal alterations in hemorrhagic fever with renal failure syndrome include features of acute interstitial nephritis, such as acute tubular necrosis with evidence of glomerular and endothelial damage. Hemorrhagic necrosis has been identified in the renal medulla. Hemorrhage is observed in different organs, especially the right atrium of the heart, the anterior pituitary gland, the pancreas, and the skin.

Pulmonary infiltrates may be observed, and, pulmonary edema is occasionally present. Infiltration of large, atypical mononuclear cells in the spleen, lymph node, and hepatic portal triad has been reported.

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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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