Nephropathia epidemica
Introduction
Nephropathia epidemica is not a quite so rare cause of acute renal failure. The disease is caused by infection with the hantavirus. Different types of hantavirus are endemic around the world. In Scandinavia, it is the relatively benign puumala virus. The virus is carried by rodents and infection occurs through excrements, as well as water from wells. The disease presents after about two weeks of incubation.
Clinical presentation
The clinical pictures is typical with a high fever, reduced general condition and headache. The suspected disease can often therefore be influensa-like disease or sepsis. A few days later, back and stomach pain occurs in the majority of patients, and the patient is occasionally hospitalised in the surgical department for acute abdomen. Kidney failure develops within a week after symptom debut, most often as an oliguric kidney failure. Laboratory tests classically show some level of leukocytosis and thrombocytopenia.
Urinalysis
Hematuria and proteinuria, but not nephrotic proteinuria, is typical. The disease can therefore be confused with RPGN based on the presentation and urinalysis.
Histopathology
Histopathologic finds are acute interstitial nephritis with a majority of mononuclear cells that especially affect the medulla. In addition, edema, bleeding and necrosis of tubule cells are also present.
Prognosis and treatment
The diagnoses is made based on the clinical presentation, and only in rare cases is biopsy indicated. Cabin trips or trips to areas with rodents should lead to suspicion. Detection of circulating antibodies by sending a sample to the Institute of Public Health will confirm the diagnosis. In many emergency rooms, there are rapid tests that will give a temporary diagnostic indication until the final serologic results are available.
The treatment is symptomatic and the prognosis is good for the Scandinavian form of the disease. The kidney function normally improves within 1-2 weeks after the disease and eventually makes a full return.
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