Hemorrhagic fever with renal syndrome: treatment

Drug treatment of hemorrhagic fever with renal syndrome

Treatment of hemorrhagic fever with kidney 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 during 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, Tyloron 0.25 mg 2 times a day on day 1, then 0.125 mg 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 not possible to take capsulated ribavirin (indomitable vomiting, coma), taking into account contraindications, intravenous ribavirin with an initial loading dose of 33 mg / kg is recommended; after 6 hours - 16 mg / kg every 6 hours for 4 days (total 16 doses); 8 hours after the last of these doses - 8 mg / kg every 8 hours for 3 days (9 doses). Treatment with ribavirin in this dose can be continued depending on the patient's condition and the opinion of the treating doctor, but should not exceed 7 days. If oral administration of ribavirin is possible, intravenous ribavirin should be discontinued and switched to encapsulated forms in accordance with the treatment scheme given above.

[1], [2], [3], [4], [5], [6], [7]

Pathogenetic treatment of hemorrhagic fever with renal syndrome

• Detoxification therapy. Intravenously injected 5-10% glucose solutions, polyionic solutions, cocarboxylase.
• Prevention of DIC syndrome. Use of disaggregants [pentoxifylline, xanthinal nicotinate, dipyridamole], in the initial period shows heparin up to 5000 units / day intravenously drip or subcutaneously, calcium supraparrin 0.3 ml / day, sodium enoxaparin 0.2 ml / day.
• Angioprotectors. Calcium gluconate, ethamylate, rutin.
• Freshly frozen plasma.
• Inhibitors of proteases (aprotinin).
• Antioxidant therapy. Vitamin E, ubiquinone.

In the oliguric period for the control of uremic intoxication, the stomach and intestines are washed with a 2% solution of baking soda, intravenous infusions of 4% sodium bicarbonate solution, the volume of administration is calculated in milliliters by the formula: OB x body weight of the patient (kg) x BE (mmol / l).

Assign enterosorbents (polyphepan, enterosorb); stimulate diuresis with furosemide in the shock dose regime (100-200 mg at one time). With anuria (less than 50 ml of urine per day), furosemide is contraindicated. If the therapy is ineffective, the use of extracorporeal hemodialysis is recommended. The following indications stand out.

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

In the polyuric period, water and salts are replenished with the use of regidron, tsitraglukosolan, mineral water, intravenous saline solutions (acesol, chlosol, etc.), potassium preparations (panangin, asparcams, 4% potassium chloride solution, 20-60 ml / day). For the treatment of inflammatory diseases of the organs of the urinary system (ascending pyelites, pyelonephritis), uroceptypes are prescribed nitroxoline, nalidixic acid, norfloxain. Nitrofurans (nitrofurantoin, furazidine).

General strengthening treatment of hemorrhagic fever with renal syndrome includes multivitamins, riboxin, cocarboxylase, sodium adenosine triphosphate. An important component of the therapy is the arrest of pain syndrome with analgesics after the exclusion of surgical pathology (metamizole, spasmalgon, baralgin, spazgan, tramadol, trimiperidine) and desensitizing drugs (diphenhydramine, promethazine, chloropyramine); relief of convulsive syndrome - diazepam, chlorpromazine. Droperidol. Sodium oxybate: arterial hypertension - aminophylline, dibazol, slow calcium channel blockers (nifedipine, verapamil): hyperpyrexia (39-41 C) - paracetamol; persistent vomiting and hiccups - procaine inside, metoclopramide intramuscularly.

In the case of ITH development (most often on the 4th-6th day of the disease) intensive anti-shock treatment of hemorrhagic fever with renal syndrome in conditions of ICU is needed, which includes the introduction of colloid (reopoliglyukin, albumin, fresh frozen plasma) and crystalloid solutions (disol, acesol) in in the ratio of 2: 1, glucocorticoids (based on prednisolone) - with IH stage I - 3-5 mg / kg per day, II stage - 5-10 mg / kg per day, Stage III - 10-20 mg / kg per day . In the absence of vasopressive effect of glucocorticoids, dopamine is indicated.

Diet and diet

Strict bed rest is necessary until the termination of polyuria.

Recommend a full meal without limiting salt, a fractional, in a warm form. In the oligurical period, products rich in potassium (vegetables, fruits) and protein (beans, 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 liquid allocated.

[8], [9], [10],

Approximate terms of incapacity for work

Depend on the clinical form and are from 3 weeks to 2-3 months.

[11], [12], [13], [14], [15],

Statement rules

The discharge of patients is performed with a satisfactory state of the patient, normalization of diuresis, laboratory indicators (urea, creatinine, hemogram) with the exception of hypoisostenuria, which persists for a long time after the infection. The issue of disability is decided individually. The term of release from work after discharge is 7-10 days with a mild form, 10-14 days with a moderate form, and 15-30 days with a heavy one.

Clinical examination

All convalescents of HFRS are subject to dispensary observation. The follow-up period for hemorrhagic fever with renal syndrome recovered with a mild form is 3 months, moderate and heavy -12 months. Supervision is conducted by an infectious disease doctor, in his absence - a district therapist. The first follow-up examination is performed 1 month after discharge from the hospital with urine, urea, creatinine, AD, then at 3, 6, 9, 12 months.

[16], [17], [18], [19], [20], [21],

What should the patient know?

Recommended nutrition is complete with the exclusion of irritating spicy food, alcoholic beverages, plentiful drink (rose hips infusion, alkaline mineral water, broths of herbs with diuretic properties), compliance with exercise regimen (heavy physical work, hypothermia, bath, sauna, sports for 6-12 months), shows the reception of restorative drugs, multivitamins, exercise therapy.

What prognosis is haemorrhagic fever with kidney syndrome?

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

Prevention of hemorrhagic fever with renal syndrome

Specific prevention of hemorrhagic fever with renal syndrome is not carried out. Korean vaccine, made on the basis of the strain Hantaan.

Hemorrhagic fever with renal syndrome is prevented by destroying rodents in the outbreaks, using respirators when working in dusty premises, storing products in warehouses protected from rodents.