Hemorrhagic fever with renal syndrome - Treatment

Drug treatment of hemorrhagic fever with renal syndrome

Treatment of hemorrhagic fever with renal syndrome is carried out in the initial period, in the first 3-5 days: ribavirin 0.2 g 4 times a day for 5-7 days, iodophenazone - according to the scheme: 0.3 g 3 times a day for the first 2 days, 0.2 g 3 times a day for the next 2 days and 0.1 g 3 times a day for the next 5 days, tilorone - 0.25 mg 2 times a day on the 1st day, then 0.125 mg for 2 days; donor specific immunoglobulin against hemorrhagic fever with renal syndrome 6 ml 2 times a day intramuscularly (course dose 12 ml), complex immunoglobulin preparation, interferon preparations in suppositories (Viferon) and parenterally (Reaferon Leukinferon). If it is impossible to take encapsulated ribavirin (uncontrollable vomiting, coma), taking into account contraindications, it is recommended to administer intravenous ribavirin with an initial loading dose of 33 mg/kg; after 6 hours - 16 mg/kg every 6 hours for 4 days (a total of 16 doses); 8 hours after the last of these doses - 8 mg/kg every 8 hours for 3 days (9 doses). Treatment with ribavirin at this dose can be continued depending on the patient's condition and the opinion of the attending physician, but should not exceed 7 days. If oral administration of ribavirin is possible, intravenous administration of ribavirin should be stopped and the patient should switch to encapsulated forms in accordance with the treatment regimen given above.

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Pathogenetic treatment of hemorrhagic fever with renal syndrome

• Detoxification therapy. 5-10% glucose solutions, polyionic solutions, and cocarboxylase are administered intravenously.
• Prevention of DIC syndrome. Disaggregants are used [pentoxifylline, xanthonol nicotinate, dipyridamole], in the initial period heparin up to 5000 U/day intravenously by drip or subcutaneously, calcium nadroparin 0.3 ml/day, sodium enoxaparin 0.2 ml/day are indicated.
• Angioprotectors. Calcium gluconate, etamsylate, rutin.
• Fresh frozen plasma.
• Protease inhibitors (aprotinin).
• Antioxidant therapy. Vitamin E, ubiquinone.

In the oliguric period, to combat uremic intoxication, the stomach and intestines are washed with a 2% solution of baking soda, intravenous infusions of a 4% solution of sodium bicarbonate are performed, the volume of administration is calculated in milliliters according to the formula: O.b x patient's body weight (kg) x BE (mmol/l).

Enterosorbents (polyphepan, enterosorb) are prescribed; diuresis is stimulated with furosemide in shock doses (100-200 mg at a time). In case of anuria (less than 50 ml of urine per day), the use of furosemide is contraindicated. If the therapy is ineffective, extracorporeal hemodialysis is recommended. The following indications are distinguished.

• Clinical: anuria for more than 3-4 days; pulmonary edema beginning against the background of oliguria; toxic encephalopathy with symptoms of beginning cerebral edema and convulsive syndrome.
• Laboratory: hyperkalemia (6.0 mmol/l and higher), urea 26-30 mmol/l and higher, creatinine more than 700-800 μmol/l, pH 7.25 and lower, BE 6 mmol/l and higher.
• Contraindications to hemodialysis:
  • ITSH;
  • massive bleeding:
  • spontaneous renal rupture;
  • hemorrhagic stroke, hemorrhagic pituitary infarction.

In the polyuric period, water and salts are replenished by oral administration of rehydron, citraglucosolan, mineral water solutions, intravenous administration of saline solutions (acesol, chlosol, etc.), and intake of potassium preparations (panangin, asparkam, 4% potassium chloride solution, 20-60 ml/day). For the treatment of inflammatory diseases of the urinary system (ascending pyelitis, pyelonephritis), uroseptics nitroxoline, nalidixic acid, norfloxacin, nitrofurans (nitrofurantoin, furazidin) are prescribed.

General tonic treatment of hemorrhagic fever with renal syndrome includes multivitamins, riboxin, cocarboxylase, sodium adenosine triphosphate. An important component of therapy is pain relief with analgesics after ruling out surgical pathology (metamizole, spazmalgon, baralgin, spazgan, tramadol, trimeperidine) and desensitizing drugs (diphenhydramine, promethazine, chloropyramine); seizure relief - diazepam, chlorpromazine, droperidol. sodium oxybate: arterial hypertension - aminophylline, dibazol, calcium channel blockers (nifedipine, verapamil): hyperpyrexia (39-41 C) - paracetamol; persistent vomiting and hiccups - procaine orally, metoclopramide intramuscularly.

In case of development of ITS (most often on the 4th-6th day of illness), intensive anti-shock treatment of hemorrhagic fever with renal syndrome in the intensive care unit is necessary, which includes the administration of colloidal (rheopolyglucin, albumin, fresh frozen plasma) and crystalloid solutions (disol, acesol) in a ratio of 2:1, glucocorticoids (based on prednisolone) - for ITS stage I - 3-5 mg / kg per day, stage II - 5-10 mg 'kg per day, stage III - 10-20 mg / kg per day. In the absence of a vasopressor effect from glucocorticoids, the administration of dopamine is indicated.

Regime and diet

It is necessary to strictly adhere to bed rest until polyuria stops.

A complete diet without limiting table salt, fractional, warm is recommended. In the oliguric period, foods rich in potassium (vegetables, fruits) and protein (legumes, fish, meat) are excluded. In polyuria, on the contrary, the use of these products is indicated. The drinking regimen should be dosed, taking into account the amount of excreted fluid.

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Approximate periods of incapacity for work

They depend on the clinical form and range from 3 weeks to 2-3 months.

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Rules of discharge

Patients are discharged if their condition is satisfactory, diuresis and laboratory parameters (urea, creatinine, hemogram) are normalized, with the exception of hypoisosthenuria, which persists for a long time after the infection. The issue of disability is decided individually. The period of release from work after discharge is 7-10 days for a mild form, 10-14 days for a moderate form, and 15-30 days for a severe form.

Clinical examination

All HFRS convalescents are subject to dispensary observation. The observation period for those who have recovered from a mild form of hemorrhagic fever with renal syndrome is 3 months, moderate and severe - 12 months. Observation is carried out by an infectious disease specialist, or, in his absence, by a local therapist. The first control examination is carried out 1 month after discharge from the hospital with a study of urine, urea levels, creatinine, blood pressure, then - after 3, 6, 9, 12 months.

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What should the patient know?

A balanced diet is recommended, excluding irritating spicy foods, alcoholic beverages, drinking plenty of fluids (rosehip infusion, alkaline mineral waters, herbal decoctions with diuretic properties), maintaining a physical activity regimen (heavy physical work, hypothermia, visiting a bathhouse, sauna, playing sports for 6-12 months are contraindicated), taking general tonics, multivitamins, and exercise therapy is recommended.

What is the prognosis for hemorrhagic fever with renal syndrome?

Hemorrhagic fever with renal syndrome has a different prognosis, which depends on the quality of medical care, the strain of the pathogen. Mortality from 1 to 10% and higher. Kidney function is restored slowly, but chronic renal failure does not develop.

Prevention of hemorrhagic fever with renal syndrome

Specific prophylaxis for hemorrhagic fever with renal syndrome is not carried out. Korean vaccine based on the Hantaan strain.

Hemorrhagic fever with renal syndrome is prevented by destroying rodents in outbreaks, using respirators when working in dusty areas, and storing food in warehouses protected from rodents.