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Hemorrhagic fever with renal syndrome
Last reviewed: 04.07.2025
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Hemorrhagic fever with renal syndrome (synonyms: hemorrhagic nephrosonephritis, Tula fever, Scandinavian epidemic nephropathy, epidemic nephrosonephritis, Churilov's disease, Far Eastern, Korean, Manchurian, Yaroslavl, Ural, Transcarpathian, Yugoslav fever, etc.)
Hemorrhagic fever with renal syndrome is an acute viral zoonotic natural focal disease characterized by systemic damage to small blood vessels, hemorrhagic diathesis, hemodynamic disorders and kidney damage with the development of acute renal failure.
Hemorrhagic fevers are a polyetiological group of acute viral zoonotic infections, united by the regular development of hemorrhagic syndrome against the background of an acute febrile condition and characterized by intoxication and generalized damage to the vessels of the microcirculatory bed with the development of thrombohemorrhagic syndrome.
Hemorrhagic fevers are dangerous or especially dangerous diseases with high mortality. This group includes at least 15 independent nosological forms. Venezuelan and Brazilian hemorrhagic fevers are variants of Argentine hemorrhagic fever.
ICD-10 code
A98.5. Hemorrhagic fever with renal syndrome.
What causes hemorrhagic fever with renal syndrome?
The causative agents of hemorrhagic fevers are classified into four families of viruses: Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae. Their genome is represented by single-stranded RNA.
The replication of the genome of these viruses occurs with low accuracy, which results in a high frequency of RNA mutations and the emergence of new virus variants with altered antigenic structure and virulence.
Most hemorrhagic fevers are natural focal infections.
The reservoir of pathogens is various species of animals. In some cases, the source of the virus is a sick person and the infection takes on an anthroponotic character.
Humans become infected with arboviral hemorrhagic fevers through transmission via the bite of infected blood-sucking arthropods (ticks, mosquitoes).
Hemorrhagic fevers caused by arenaviruses, filoviruses and some bunyaviruses are spread by contact, airborne and parenteral routes.
Human susceptibility to hemorrhagic fevers varies widely and depends on the variability of the virus.
Pathogenesis of hemorrhagic fever
Replication of viruses - causative agents of hemorrhagic fevers occurs mainly in the endothelial cells of the microcirculatory bed, which is accompanied by microcirculation disorders and the development of hemorrhagic syndrome and infectious-toxic shock. These features allow us to consider hemorrhagic fevers in one group of diseases. Clinically, the commonality of hemorrhagic fevers is determined by the presence of febrile-intoxication and hemorrhagic syndromes. Diagnostics of hemorrhagic fevers is carried out by virological and immunological methods. The basis of treatment is pathogenetic therapy. Specific prevention methods have not been developed. Due to the severity of the course, high mortality, epidemiological uncontrollability, hemorrhagic fevers are classified as especially dangerous and dangerous infectious diseases.
What are the symptoms of hemorrhagic fever with renal syndrome?
Hemorrhagic fever with renal syndrome has an incubation period of 4 to 49 (on average 14-21) days. The disease is characterized by a clear cyclical course and a variety of symptoms, from abortive febrile forms to severe ones, with massive hemorrhagic syndrome and persistent renal failure. The following periods are distinguished: initial (febrile), oliguric, polyuric, convalescent (early - up to 2 months and late - up to 2-3 years). Prodromal phenomena in the form of malaise, chills, fatigue, subfebrile condition, lasting 1-3 days, are observed in no more than 10% of patients.
Where does it hurt?
How is hemorrhagic fever with renal syndrome diagnosed?
Hemorrhagic fever with renal syndrome is diagnosed based on characteristic symptoms, a combination of acute onset of the disease with the appearance of fever and symptoms of intoxication, kidney damage with the development of acute liver failure and hemorrhagic syndrome.
Staying in an endemic area, nature of professional activity.
Cyclic course with a natural change of infectious-toxic symptoms of the initial period (fever, headache, weakness, hyperemia of the face, neck, upper third of the chest, mucous membranes, injection of scleral vessels) signs of increasing renal failure of the oliguric period (pain in the lower back, abdomen; vomiting not associated with food intake; decreased visual acuity against the background of severe headache, dry mouth, thirst; severe hemorrhagic syndrome, decreased diuresis to less than 500 ml / day).
How to examine?
How is hemorrhagic fever with renal syndrome treated?
Hemorrhagic fever with renal syndrome requires strict 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.
Hemorrhagic fever with renal syndrome is treated with medication 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 HFRS 6 ml 2 times a day intramuscularly (course dose 12 ml), complex immunoglobulin preparation, interferon preparations in suppositories (Viferon) and parenterally (Reaferon Leukinferon).
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 and the strain of the pathogen. Mortality is from 1 to 10% and higher. Kidney function is restored slowly, but chronic renal failure does not develop.