[Acute renal pain as an adverse reaction of the rabies immunization].
BACKGROUND
HRIG is the best preparate in rabies prophylaxis, and it's considered that optimal dose is 20 international units per kilogram and must not been reduced or overdosed. HRIG have to be injected infiltrative around bite wounds, and if after that remains a part of the dose, it has to be given in gluteal muscle. Application only in gluteus is vitium artis.


METHODS
At one patient immunized against rabies has occured acute bilateral renal pain and fever at time of immunization against rabies, and because of that vaccination must been stopped after the 3rd dose of vaccine. Patient was a 26-year-old female without significant pre-existing disease, bitten by stray dog. After the start of immunization, because the wrong direction, she received about 2.5 more amount of human rabies immunoglobuline (HRIG) then is recommended on declaration at etiquette of ampoule, and only in gluteus in quantity of 10.5 ml.


CONCLUSIONS
Glomerulonephritis after rabies vaccination until now was described just once by Singhal et al. in 1981. year. Acute renal pain, after rabies vaccine, which aggravated after repeated vaccine doses in our patient who received overdosed HRIG, may be explained by immunopathological mechanism, rather with formation of circulating immune complexes, their precipitation on the glomerular basement membrane and developing glomerulonephritis.


CONCLUSIONS
Low weight soluble molecular immune complexes formed when antigen is in excess, as in case after repeated doses of rabies vaccine, circulate and precipitate on glomerular membrane and causes glomerulonephritis. As contribution to this explanation, is that symptoms as renal pain disappeared after interrupting vaccination protocol in our patient.
Lalosević
Dusan
D
Klinicki centar Vojvodine, Centar za patologiju i histologiju, Medicinski fakultet Novi Sad.
D000208:Acute Disease; D000818:Animals; D001733:Bites and Stings / Q000821:virology; D004285:Dogs; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology* / Q000276:immunology; D008508:Medication Errors; D010146:Pain / Q000209:etiology*; D011819:Rabies Vaccines / Q000009:adverse effects*
D011819:Rabies Vaccines