Nephropathy epidemica
Introduction
Nephropathy epidemica is not entirely rare cause of acute renal failure. The disease is caused by infection with hantavirus. Different types of hantavirus is endemic around the world. In Scandinavia it relatively benign puumelaviruset. The vector is rodents and contagion occurs via excrement, also from well water. The disease breaks out after about two week incubation period. Clinical presentation
The clinical picture is classic tumultuous with high fever, reduced general condition and headache. One can therefore suspicious influenza-like illness or sepsis. A few days later apply spinal and abdominal pain in the majority of patients and patient admitted sometimes the surgical ward for acute abdomen. Renal failure develops within a week after onset, most often as a oligurisk kidney failure. Laboratory purposes are any degree of leukocytosis and thrombocytopenia is classic. Urinary Findings
Hematuria and proteinuria, but not nephrotic proteinuria is classic. The disease can therefore be confused with RPGN from stream and urinary findings. Histopathology
Histopathological's acute interstitial nephritis with predominantly mononuclear cells which particularly affects medulla. Additionally seen edema, hemorrhage and necrosis of tubular cells. Course and treatment
The diagnosis is made clinically, and in rare cases a biopsy may be indicated. Suspicion should be awakened at a cabin or outing in a place with small rodents. Detection of circulating antibodies by sending try to Institute of Public Health will confirm the diagnosis. In many emergency rooms are rapid tests that will give a preliminary diagnostic indication until you get a final answer on serology. Treatment is symptomatic and the prognosis is good at the Scandinavian form of disease. Renal function takes normally up after 1-2 weeks of disease and normalize eventually complete. Read more about nephropathy epidemica
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