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Query: UMLS:C0012739 (disseminated intravascular coagulation)
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Clinical symptoms and laboratory measures of renal and liver function, coagulation, and inflammatory parameters were prospectively studied in 74 hospitalized patients (14-74 years of age) with serologic evidence of nephropathia epidemica. The most common clinical findings were acute onset of symptoms, fever (greater than or equal to 38 degrees C), thirst, headache, nausea, back pain, vomiting, myalgia, and abdominal pain. Twenty-seven patients (37%) had hemorrhagic manifestations, i.e., epistaxis, melena, hematemesis, petechial bleeding, macroscopic hematuria, or metrorrhagia. Disseminated intravascular coagulation developed in four patients. Fifty-one percent had thrombocytopenia. Proteinuria was recorded for all patients, while hematuria and glucosuria were noted for 85% and 58%, respectively. Serum creatinine levels were elevated in 71 (96%) of the patients. Levels of C-reactive protein or erythrocyte sedimentation rates were elevated in all cases, usually to levels found in serious bacterial diseases. Sixty-six (89%) of the patients were followed for up to 7 months, at which time all had recovered clinically. No patient died or required dialysis. We conclude that nephropathia epidemica in Sweden has a clinical picture similar to that of hemorrhagic fevers in other parts of the world, but with a milder course and a better prognosis.
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PMID:Clinical characteristics of nephropathia epidemica in Sweden: prospective study of 74 cases. 257 3

BACKGROUND: Leptospirosis (LS) and Hantavirus (HV) infection have many common clinical manifestations, including acute renal failure. In as much as clinical experience with these diseases is quite limited in urban centers, we identified cases of Leptospira and HV-induced acute renal failure and compared the clinical course and evolution of these diseases. METHODS: Patients hospitalized with acute renal failure, suspected to be caused by infection, were retrospectively studied over a 13-year period (1985-1998). Based on pertinent clinical data and positive serology, a total of 26 patients were included in the study, 17 patients with LS and 9 patients with HV infection. RESULTS: Both diseases presented as flu-like syndromes with high fever. In LS, 2 patients presented with acute meningitis and died soon after admission. Symptoms and signs from other organs began after the fifth day of illness. Jaundice occurred in 71% of LS patients but not in HV. Hemorrhagic phenomena occurred in both diseases but affected predominantly patients with icteric LS. Anuria or oliguria occurred in 76% of patients with LS and 78% with HV infection. Laboratory studies demonstrated minor transaminase elevations in all patients with LS and in 44% with HV. Hypoprothrombinemia or thrombocytopenia was uncommon, although disseminated intravascular coagulation (DIC) developed in 2 patients that had icteric Ls and major bleeding. Nephropathy was associated with haematuria in 71% with LS and all patients with HV. Proteinuria was evident in 35% of patients with LS compared to 78% with HV. Abnormal chest radiographs were seen in 24% with LS and in 33% with HV. In both diseases, aggressive supportive treatment was given, including hemodialysis or peritoneal dialysis in 4/26 patients. Of the 26 patients, 22 survived and four died. The latter all had LS, and the causes of death were meningitis and DIC with multiple organ failure. Follow-up, after 6 months, showed that renal function had returned to normal in the 22 survivors. CONCLUSION: It is important to include LS and HV infection in the differential diagnosis of acute renal failure. Both diseases present with flu-like symptoms and may be complicated by thrombotic microangiopathy with hemorrhagic phenomena and hepatic and pulmonary involvement. Jaundice should alert the physician to icteric LS, a severe disease associated with significant mortality that requires antimicrobial treatment.
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PMID:Acute renal failure caused by leptospirosis and Hantavirus infection in an urban hospital. 1206 23