Acute renal insufficiency in hemorrhagic fever with renal syndrome

PURPOSE: Propranolol, a beta-adrenergic antagonist, has been shown to block hyperthermically-induced ocular recurrence of HSV-1 in mice and reduce spontaneous ocular viral shedding and herpetic corneal lesions in latently infected rabbits. The present study was performed to determine the effect of propranolol on epinephrine iontophoresis-induced ocular recurrence and immunosuppression-induced ocular recurrence in the rabbit eye model. METHODS: New Zealand white rabbits were infected with HSV-1 strain 17Syn+ or McKrae. After latency was established, the animals were injected intramuscularly with saline (placebo), or propranolol (5-200 mg/kg) twice daily, and then induced with epinephrine iontophoresis or cyclophosphamide and dexamethasone administration. Tear film swabs were cultured to determine the frequency of viral shedding. RESULTS: Propranolol administered at a range of doses did not affect the frequency or duration of viral shedding following epinephrine or cyclophosphamide/dexamethasone induction as compared to saline treatment. CONCLUSION: These results demonstrate that propranolol does not significantly reduce ocular HSV-1 shedding following induction by epinephrine iontophoresis or immunosuppression. By inference, these results suggest two possibilities: (1) that viral pathways leading to spontaneous and induced shedding of virus are under separate control mechanisms or (2) in rabbits, these inducers are of such potency that propranolol is ineffectual.     

Serotonin concentration in the blood of patients with hemorrhagic fever with renal syndrome

Differences in the concentrations of serotonin in whole blood and plasma of patients with hemorrhagic fever with the renal syndrome prompted measurements of serotonin in different components of the blood. The concentration of serotonin in whole blood was found to depend on its hemoconcentration: the higher is the hematocrit, the greater is the difference between serotonin content in the plasma and whole blood. In case of hemoconcentration or hemodilution it is impossible to assess serotoninemia from the level of serotonin in whole blood.     

An epidemic of hemorrhagic fever with renal syndrome in Croatia in 1995

In the spring of 1995, the largest outbreak of hemorrhagic fever with renal syndrome (HFRS) so far was recorded in Croatia. There were 125 patients reported to the National Croatian Institute of Public Health, Department of Epidemiology. The disease occurred simultaneously in several localities, some of them close to the previously known natural foci (Mala Kapela, western Slavonia); the focus on Dinara was newly discovered. War circumstances in Croatia were closely related to this outbreak. There were 50 patients hospitalized in the University Hospital of Infectious Diseases in Zagreb; 5 of them were civilians from Zagreb area and 45 soldiers (Mala Kapela 33, Dinara 7, western Slavonia 5). In all patients the disease was serologically proven (in 6 by indirect immunofluorescence method and in 44 by ELISA-test). Both previously known types of viruses--Hantaan and Puumala were diagnosed in each locality. In general, the illness was more severe in patients with Hantaan virus infection. Two patients died, the illness was severe in 25, moderately severe in 11 and mild in 12 patients. For the first time inflammatory lung changes were recorded in 13 out of 37 (35.1%) patients who were examined by X-ray in the early stage of the disease.     

The hemodynamic and laboratory biochemical characteristics of the nephropathy in convalescent patients after hemorrhagic fever with renal syndrome

Laboratory and functional tests were made in 50 convalescents who had suffered hemorrhagic fever with renal syndrome (HFRS). It is shown that nephropathy in such patients runs with a decline in renal functional reserve indicative of intraglomerular hypertension, impaired ability of the kidneys for osmotic urine concentration, defective tubular reabsorption of beta 2-microglobulin, microcirculatory disorders, collagen disbolism, high levels of uric acid in the blood. The occurrence of hyperuricemia and intraglomerular hypertension in HFRS convalescents calls for special consideration as leading nonimmune factors of nephropathy progression.     

Splenic vein thrombosis with pancytopenia and fever: antiphospholipid antibody syndrome

Antiphospholipid antibody syndrome (APS) is now recognized as one of the most important causes of hypercoagulability. The most common site for venous thrombosis in APS is deep venous thrombosis of the lower extremities. Other sites of venous thrombosis include retinal veins, renal veins, and hepatic veins. The authors report a case of splenic vein thrombosis disclosing antiphospholipid syndrome in which also the cytolytic effect of aPL may play a role of "cofactor" in the genesis of thrombosis through the release of thromboplastin from the lysis of red cells, granulocytes and platelets, making them vulnerable to clearance by splenic macrophages. Important considerations are stressed about differential diagnosis, etiopathogenetic factors, therapy and follow-up of the patient.     

Nephrotic syndrome and renal insufficiency associated with lithium therapy

OBJECTIVES: To assess the effects of a single dose of a non-absorbable fat substitute, sucrose polyester, on gastrointestinal function. METHODS: The effects of 50 g of sucrose polyester taken as a single drink on gastric emptying, small bowel transit time (SBTT), whole gut transit time (WGTT) and faecal weight compared with a control fat were examined in double-blind studies. The effect of sucrose polyester on gallbladder ejection fraction and gastrointestinal hormones was also assessed. RESULTS: Sucrose polyester was found to accelerate gastric emptying significantly (98.33 +/- 71.0 vs. 112.92 +/- 82.0 min, P = 0.042) but to slow SBTT (153.75 +/- 36.25 vs. 128.75 +/- 47.39 min. P = 0.006). A trend to faster WGTT (37.47 +/- 15.61 vs. 46.63 +/- 20.65 h) and increased faecal weight was observed (453.33 +/- 122.05 vs. 395.0 +/- 107.85 g/48 h), but this did not reach statistical significance. There was a striking reduction in gallbladder ejection fraction with sucrose polyester (21.69 +/- 25.32 vs. 45.27 +/- 27.67%), P = 0.039) and a corresponding significant decrease in the release of cholecystokinin. Lower levels of motilin and enteroglucagon were also observed. CONCLUSIONS: Sucrose polyester has significant effects on gastrointestinal transit, gallbladder contraction and gastrointestinal hormones. These effects can be explained on the basis of decreased luminal products of digestion and may have implications for the widespread use of sucrose polyester as a fat substitute.     

Reversible nephrotic syndrome in Crohn's disease complicated with renal amyloidosis

A 24-year-old woman suffered from ano-rectal Crohn's disease and nephrotic syndrome due to glomerular amyloidosis AA. She received azathioprine and colchicine for two years. Both Crohn's disease and nephrotic syndrome resolved. However amyloid renal lesions were still present. This course is exceptional, and leads to a discussion of the treatment of amyloidosis associated with Crohn's disease.     

Acute renal failure and nephrotic syndrome with alpha interferon therapy

Analysis of dimethylsulfoxide reductase from Rhodobacter capsulatus showed that it contained 1 mol Mo and 2 mol GMP. This indicates that the molybdenum cofactor in dimethylsulfoxide reductase is bis(molybdopterin guanine dinucleotide) molybdenum. The absorption spectrum of the molybdopterin guanine dinucleotide released from dimethylsulfoxide reductase after denaturation of the holoenzyme was compared with those of pterin standards of known redox state. The spectra were most similar to pterin standards in the dihydro state and oxidised state. The reduction of 2,6-dichloroindophenol by molybdopterin guanine dinucleotide released from dimethylsulfoxide reductase and by pterin standards was also measured and approximately 2 mol electrons/2 mol molybdopterin guanine dinucleotide were found to reduce 2,6-dichloroindophenol. These results are consistent with the presence of one molybdopterin guanine dinucleotide moiety with a pyrazine ring at the oxidation level of a dihydropteridine and one molybdopterin guanine dinucleotide moiety with a pyrazine ring at the oxidation level of a fully aromatic pteridine. It is suggested that the pyrazine ring of Q-molybdopterin guanine dinucleotide is fully aromatic and contains a 5,6 double bond.     

Neonatal renal arterial embolism syndrome

Attention is called to a poorly recognized syndrome of neonatal renal arterial embolism, presumably from the ductus arteriosum, resulting in malignant hypertension, congestive heart failure, respiratory distress, and increased renin secretion. Radiographic studies revealed a ductus diverticulum and multiple narrowed arteries including the lower pole branches of the right renal artery. Renal scan showed poor imaging of the lower pole of the right kidney. Nephrectomy resulted in a prompt return of the blood pressure into the normal range. Eight cases recorded in the literature resemble the one reported here, and six of the eight had an associated thrombosis of the ductus arteriosum. Our patient appears to be the first case recognized by modern techniques followed by nephrectomy and clinical cure.