Renal involvement in human rabies: clinical manifestations and autopsy findings of nine cases from northeast of Brazil.
A retrospective study was conducted in nine patients with rabies admitted to a hospital of Fortaleza, Brazil. Autopsy was performed in all cases. The ages ranged from three to 81 years and six were males. They all were bitten by dogs. The time between the accident and the hospital admission ranged from 20 to 120 days (mean 45 +/- 34 days). The time until death ranged from one to nine days (mean 3.3 +/- 5.5 days). The signs and symptoms presented were fever, hydrophobia, aerophobia, agitation, disorientation, dyspnea, sialorrhea, vomiting, oliguria, sore throat, pain and hypoesthesia in the site of the bite, headache, syncope, cough, hematemesis, mydriasis, hematuria, constipation, cervical pain and priapism. In three out of six patients, there was evidence of acute renal failure, defined as serum creatinine > or = 1.4 mg/dL. The post-mortem findings in the kidneys were mild to moderate glomerular congestion and mild to intense peritubular capillary congestion. Acute tubular necrosis was seen in only two cases. This study shows some evidence of renal involvement in rabies. Histopathologic findings are nonspecific, so hemodynamic instability, caused by autonomic dysfunction, hydrophobia and dehydration must be responsible for acute renal failure in rabies.
Hospital Universitário Walter Cantídio, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brasil. efdaher@for.terra.com.br
Elizabeth De Francesco
Ede F
Daher
Geraldo Bezerra
GB
da Silva Júnior
Marúsia Thomaz
MT
Ferreira
Fernando Antonio de Sousa
FA
Barros
Tiago Magalhães
TM
Gurgel
Régia Maria do Socorro Vidal
RM
Patroćinio
D058186:Acute Kidney Injury / Q000209:etiology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001733:Bites and Stings / Q000150:complications*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D005260:Female; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011818:Rabies / Q000150:complications* / Q000473:pathology / Q000635:transmission; D012189:Retrospective Studies; D012720:Severity of Illness Index