Successful treatment of severe hantavirus nephritis with corticosteroids: a case report and literature review.
Hantaviruses can be associated with severe form of hemorrhagic fever with renal syndrome although there are only a few cases reporting chronic kidney disease after hantavirus infection. We report a severe nonresolving chronic renal failure after protracted Dobrava hantavirus infection successfully treated with corticosteroids. Ten days after working in a basement a 33-year-old man fell seriously ill, with high fever, chills, diffuse myalgia, headache and abdominal pain. After hospital admission a diagnosis of hemorrhagic fever with renal syndrome caused by Dobrava hantavirus was made. Acute oliguric kidney injury developed in the first 3 days after admission, in a few days diuresis restored and he became polyuric. Nevertheless renal failure persisted and he needed hemodialysis. Because of nonresolving kidney failure, nephrogenic diabetes insipidus and renoparenchymal arterial hypertension persisting 2 months after onset of symptoms, a kidney biopsy was performed, showing severe necrotizing tubulointerstitial nephritis. High dose methylprednisolone therapy was started and his renal function significantly improved. Two months later a second renal biopsy showed persisting elements of active necrotizing tubulointerstitial nephritis. We decided to stop corticosteroid treatment and introduced aldosterone antagonist eplerenon as anti-fibrotic agent, and his renal function further improved and remained stable. Nine months later his serum creatinine concentration was 227 μmol/L, proteinuria 0.156 g/day and well controlled nephrogenic diabetes insipidus.
General Hospital Nova Gorica, Ljubljana, Slovenia.
Maja
M
Martinuč Bergoč
Jelka
J
Lindič
Damjan
D
Kovač
Dušan
D
Ferluga
Jernej
J
Pajek
D000328:Adult; D004305:Dose-Response Relationship, Drug; D000077545:Eplerenone; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D018778:Hantavirus Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods; D012720:Severity of Illness Index; D013148:Spironolactone / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D005938:Glucocorticoids; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone; D008775:Methylprednisolone
Chronic kidney disease; Corticosteroids; Dobrava hantavirus; Eplerenone; Hemorrhagic fever with renal syndrome