Papadimitriou MG
Hantavirus nephropathy
Kidney Int
(Sep) 49:887-902 1995
Hantavirus infection is an important and endemic cause of
acute renal failure in certain regions of the world. The virus is
transmitted by aerosolization of rat droppings, the main natural host of
these organisms. Acute infection in humans is now well recognized as a
cause of hemorrhagic fever with renal syndrome (HFRS), the latter being
expressed in a highly variable fashion, ranging from mild renal
impairment to severe oliguric renal failure with shock and disseminated
intravascular coagulation. In its most severe form hantavirus infection
is associated with widespread vascular dysfunction, shock and renal
shutdown. In this review Dr. Papadimitriou discusses the history,
clinical picture, immunology, management and prophylactic measures for
Hantavirus nephropathy. The prevalence of clinical and laboratory
findings and prognosis in patients with various types of HFRS caused by
different strains of Hantaan viruses is presented in detail. In
addition, the global distribution of various strains and their relative
virulence with regard to renal manifestations are discussed.
Hypothetical mechanisms of Hantavirus induced renal disease and clinical
shock as well as immune-mediated mechanisms of vascular injury are
described
Dr. Papadimitriou is joined by a group of distinguished
experts on Hantavirus nephropathy from around the world. The
discussants provide additional insights into the molecular biology,
pathogenesis and management of this disease. Most intriguing however, is
a discussion of the possible role of these viruses in the pathogenesis
of chronic progressive renal failure. Data from a Baltimore study are
described where serologic evidence of Seoul Hantavirus infection was
found in patients with hypertensive renal disease. One idea is that
chronic viral infection might lead to immune reaction to the virus with
healing and subsequent progressive renal disease. This new hypothesis
is most interesting and definitely worth your time.
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ARF etiology :
Acute glomerulonephritis/RPGN
Proteinuria/Hematuria :
Other systemic infections