[Epidemic nephropathy. An important differential diagnosis of acute renal failure in Reutlingen, an endemic area]

Abstract

Background and objective: Hantavirus ("epidemic") nephropathy (HN), or hemorrhagic fever with renal syndrome (WHO nomenclature), is an infection caused by strains (e.g. Puumala) of Hantavirus, which is often accompanied by acute renal failure. Although its typical symptomatology has been fully reported, it is rarely included in the differential diagnosis of renal nephropathy. This study investigated whether, in the presence of typical symptoms, specific search for a certain constellation of laboratory values in association with a typical history can more often provide the diagnosis of HN.

Patients and methods: 18 patients (4 females, 14 males; average age 41 years) fulfilled the following inclusion criteria: abnormal values for creatinine, LDH and C-reactive protein, proteinuria and hematuria, as well as thrombocytopenia in conjunction with fever, back- and headache. After the diagnosis had been confirmed by demonstrating antibodies against the Puumala strain of hantavirus, follow-up included laboratory tests and clinical observation.

Results: All patients fully recovered without any sequelae. There was a clearly increased frequency of cases at the Reutlingen Clinic compared with the previous years (maximally 7 cases per year in 1995-1999). The incidence in the Reutlingen region was probably at least 6.5/100 000 inhabitants.

Conclusion: At least in endemic regions HN is one of the most common causes of acute renal failure. The increase of cases can, among other reasons, be explained by the described prospective diagnostic schema. But climatic factors with changes in the density of the vector (bank vole) cannot be excluded.