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Hemorrhagic fever with renal syndrome: diagnosis

Alexey Kryvenko, medical expert
Last reviewed: 23.04.2024

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Hemorrhagic fever with renal syndrome is characterized by a combination of acute onset of hemorrhagic fever with renal syndrome with the appearance of fever and symptoms of intoxication, kidney damage with the development of acute hepatic insufficiency and hemorrhagic syndrome.

trusted-source [1], [2], [3], [4], [5], [6], [7]

Indications for consultation of other specialists

Consultation of the surgeon for the exclusion of acute surgical diseases of the abdominal organs, with suspicion of a rupture of the kidney. Consultation of the resuscitator in case of development of infectious-toxic shock in acute renal failure to resolve the issue of hemodialysis.

Indications for hospitalization

Hemorrhagic fever with renal syndrome requires mandatory early admission to infectious or therapeutic hospitals, regardless of the severity and period of the disease. Outpatient observation and treatment of hemorrhagic fever with renal syndrome is unacceptable. Transportation of the patient should be as gentle as possible, with the exception of shocks and shaking.

Differential diagnostics

Nosoforms	General symptoms	Differences
OGL	Acute onset, fever hemorrhagic syndrome	Fever of the two-wave hemorrhagic syndrome is poorly expressed, proteinuria is low. ARF does not develop. Pain in abdomen and lower back absent or minor. Characterized by the defeat of the central nervous system and lungs. Detect specific antibodies in DSC and PH
Rickettsiosis from the group of spotted fevers	Acute onset, fever hemorrhagic kidney damage syndrome	The fever is long, the central nervous system and cardiovascular system predominate. Primary affect rash profuse mainly rosaceous-spotted-papular, with secondary petechiae enlarged spleen polyadenopathy In severe cases - nasal bleeding. Defeat of the kidneys is limited to proteinuria. There are specific antibodies in the RIF and RSK
Meningococcemia	An acute onset of fever. Hemorrhagic syndrome. Kidney damage with development of arresters	During the first day there is a hemorrhagic rash, OPN hemorrhagic syndrome only against the background of ITH, which develops on the first day of the disease. Most patients (90%) develop purulent meningitis. Mark leukocytosis. In the blood and CSF, bacterioscopically and bacteriologically, meningococci, a positive RLA
Acute surgical diseases of the abdominal cavity	Pain in the abdomen and tenderness of palpation, a symptom of irritation of the peritoneum, fever, leukocytosis	Pain syndrome precedes fever, other symptoms. Pain and signs of irritation of the peritoneum initially have a localized character. Hemorrhagic syndrome and kidney damage are not characteristic. Neutrophilous leukocytosis in the blood from the first hours of the disease
Acute diffuse glomerulonephritis	Fever kidney damage with oliguria possible arthritis, hemorrhagic syndrome	Fever, sore throat, ARI precede kidney damage within 3 days to 2 weeks. Characteristic pallor of the skin, edema. Persistent increase in blood pressure. Hemorrhagic syndrome is possible against a background of azotemia, manifested by a positive symptom of the tourniquet, new bleeding
Leptospirosis	Acute onset, fever hemorrhagic rash, lesion	The onset of a violent fever lasting, sharply pronounced myalgia often meningitis jaundice from the first day of high leukocytosis. Proteinuria. Moderate or low. Anemia. Detection of leptospira in blood smears of urine CSF Micneutralization reaction and PAL - positive

Epidemiological anamnesis

Stay in an endemic focus, the nature of professional activity.

trusted-source [8], [9], [10],

Seasonality

The cyclicity of the course with a regular change in infectious-toxic symptoms of the initial period (fever, headache, weakness, hyperemia of the face, neck, upper third of the breast, mucous membranes, injection of scleral vessels) signs of increasing renal insufficiency of the oliguric period (pain in the loin, abdomen, vomiting, not associated with food intake, decreased visual acuity against a background of severe headache, dry mouth, thirst, severe hemorrhagic syndrome, decreased diuresis to less than 500 ml / day.

Nonspecific laboratory diagnostics of hemorrhagic fever with renal syndrome

The informativeness of laboratory nonspecific (general clinical, biochemical, coagulopathic, electrolyte, immunological) and instrumental (EGDS, ultrasound, CT, ECG, roentgenography of OGC, etc.) is relative, as they reflect the severity of nonspecific pathophysiological syndromes - acute renal failure, DVS and others , they should be evaluated taking into account the period of the disease.

Clinical blood test: in the initial period - leukopenia, an increase in the number of erythrocytes, hemoglobin, decreased ESR, thrombocytopenia; in the midst of the disease - leukocytosis with a shift of the formula to the left, an increase in ESR up to 40 mm / h.

The general analysis of urine: proteinuria (from 0.3 to 30.0 g / l and above), micro- and macrohematuria, cylindruria, Dunaevsky cells.

Zimnitsky's trial: hypoisostenuria.

Biochemical blood test: increased urea concentration, creatinine, hyperkalemia, hyponatremia, hypochloraemia.

Coagulogram: Depending on the period of the disease, signs of hypercoagulability (shortening of thrombin time to 10-15 s, clotting time, increase in fibrinogen concentration to 4.5-8 g / l, prothrombin index up to 100-120%) or hypocoagulation (thrombin time extension up to 25-50 s, prolongation of the clotting time, reduction of the fibrinogen concentration to 1-2 g / l of the prothrombin index to 30-60%).

Specific laboratory diagnosis of hemorrhagic fever with renal syndrome

RNIF: studies are conducted in paired sera taken at intervals of 5-7 days. Diagnostic significance is considered to increase antibody titer 4 times or more. The method is highly effective, the confirmation of the diagnosis reaches 96-98%. To increase the effectiveness of serodiagnostics of hemorrhagic fever with renal syndrome, it is recommended to take the first serum before the 4-7th day of the disease, and the second - not later than the 15th day of the disease. Also used solid-phase ELISA, which allows to determine the concentration of IgM-antibodies. For the purpose of early diagnosis, PCR is used to detect fragments of viral RNA in the blood.

Instrumental diagnostics of hemorrhagic fever with renal syndrome

Kidney ultrasound, ECG, chest X-ray.

Criteria for severity of hemorrhagic fever with renal syndrome

Easy flow:
- fever (up to 38.0 C);
- oliguria (up to 900 ml / day);
- microproteinuria;
- microhematuria;
- the serum urea concentration is normal, and the creatinine level is raised to 130 μmol / l.
Medium-heavy current:
- fever (up to 39.5 C);
- headache, frequent vomiting;
- intense pain in the lumbar region, abdominal pain;
- hemorrhagic rash;
- oliguria (300-900 ml / day);
- moderate azotemia (urea in the blood plasma to 18 mmol / l, creatinine up to 300 μmol / l).
Heavy Current:
- complications in the form of ITSH and acute vascular insufficiency;
- hemorrhagic syndrome;
- oliguria (less than 300 ml / day) or anuria;
- uremia (urea concentration above 18.5 mmol / l, creatinine - above 300 μmol / l).
Harbinger of severe development (on day 2-4):
- severe pain in the lower back and abdomen;
- sharp reduction in visual acuity against a background of severe headache, dry mouth and thirst;
- multiple vomiting, not associated with eating;
- pronounced hemorrhagic syndrome:
- oliguria (less than 500 ml / day);
- leukocytosis;
- massive proteinuria (3.3 g / l and more);
- a sharp rise in the concentration of urea and creatinine from the 3rd day of the disease.

trusted-source [11], [12], [13], [14], [15], [16]

Differential diagnosis of hemorrhagic fever with renal syndrome

Differential diagnostics of hemorrhagic fever with renal syndrome is performed with other hemorrhagic fevers, but the distribution area of their distribution does not coincide with the distribution area of hemorrhagic fever with renal syndrome, except for OGL. In the initial period of the disease, differential diagnostics with influenza, rickettsiosis, tick-borne encephalitis, further with diseases characterized by a triad of symptoms: fever, kidney damage, hemorrhagic syndrome. Differential diagnostics with acute surgical diseases of the abdominal cavity is relevant.

trusted-source [17], [18], [19], [20], [21]