L.R. IMAYEVA^1, 2, R.Z. AKHMETSHIN¹, D.KH. KHUNAFINA¹, G.P. SHIRYAEVA¹, S.V. SHAGAROVA¹, D.S. VALEYEVA²

¹Bashkir State Medical University, Ufa

²Republican Children’s Clinical Hospital, Ufa

Contact details:

Imayeva L.R. — PhD (Medicine), Associate Professor of the Department of Pediatrics, nephrologist

Address: 152/3 Mendeleev St., 450080 Ufa, Russian Federation, tel.: +7-986-979-30-16, e-mail: liliyaraz@mail.ru

 As a result of systemic damage to the endothelium of small vessels in hemorrhagic fever with renal syndrome (HFRS), a polymorphic clinical picture develops in a short time, which often makes it difficult to detect the disease early. One of the serious complications of HFRS in children is the development of acute kidney injury (AKI).

The purpose — to determine the severity of clinical manifestations of HFRS complicated by AKI in children; to evaluate the effectiveness of pathogenetic therapy.

Material and methods. We analyzed medical records of 32 children from 2 to 17 years old with AKI against the background of HFRS, treated at Republican Children’s Clinical Hospital (Ufa). The stages of AKI were distinguished in accordance with the international criteria of AKIN (2012). The control group consisted of 30 healthy children aged 3–17 years.

Results. The majority of patients with HFRS complicated by AKI were adolescents aged 12–17 years — 15 persons (46.9%). Boys were more likely to get sick — 21 patients (66%). In all patients (100%), the course of HFRS complicated by AKI was characterized by cyclicity — a sequential change of febrile, oligoanuric, polyuric, and recovery periods. Acute kidney injury in 32 children (100%) developed at the end of the febrile period of HFRS. Of these, stage I AKI occurred in 21 patients (65.6%), stage II in 4 (12.5%), and stage III in 7 children (21.9%). All patients underwent complex treatment (infusion therapy with glucose-saline solutions, taking into account diuresis on the previous day, antiviral drugs, correction of metabolic and electrolyte disorders of the blood, syndrome-by-syndrome treatment). Only 1 child (3.1%) out of 32 children with AKI against the background of HFRS required renal replacement therapy (hemodialysis). There were no fatalities.

Conclusion. The study of children with HFRS complicated by AKI demonstrate the importance of collecting an epidemiological history, identifying characteristic clinical and laboratory manifestations of the disease, using timely diagnostic measures (including international criteria for AKI), comprehensive pathogenetic therapy, and a multidisciplinary medical approach to ensure the recovery of these patients.

Key words: hemorrhagic fever with renal syndrome, acute kidney injury, children.

REFERENCES

1. Pavlov V.N., Fazlyeva R.M. et al. Gemorragicheskaya likhoradka s pochechnym sindromom. Aktual’nye voprosy patogeneza, kliniki, diagnostiki i lecheniya [Hemorrhagic fever with renal syndrome. Current issues of pathogenesis, clinical features, diagnostics and treatment]. Moscow: GEOTAR-Media, 2019. 160 p.
2. Infektsionnye bolezni: natsional’noe rukovodstvo, pod. red. N.D. Yushchuka, Yu.Ya. Vengerova [Infectious diseases: national guidelines, edited by N.D. Yushchuk, Yu.Ya. Vengerov]. Moscow, GEOTAR-Media, 2018. 1056 p.
3. Ling J., Verner-Carlsson J., Eriksson P., Plyusnina A., Mare Löhmus J.D. et al. Genetic analyses of Seoul hantavirus genome recovered from rats (Rattus norvegicus) in the Netherlands unveils diverse routes of spread into Europe. J. Med. Virol, 2019, vol. 91 (5), pp. 724–730.
4. Khunafina D.Kh., Valishin D.A., Shaykhullina L.R. et al. Hemorrhagic fever with renal syndrome (literature review). Int. J. Experimental Education, 2014, no. 8, pp. 14–17 (in Russ.).
5. Bulatova A.Kh., Khaertynova I.M., Shakirova V.G. Features of the course of hemorrhagic fever with renal syndrome in children of different age groups. Prakticheskaya meditsina, 2022, vol. 20, no. 7, pp. 57–60 (in Russ.).
6. Bulatova A.Kh., Khaertynova I.M., Shakirova V.G. et al. Clinical and laboratory characteristics of hemorrhagic fever with renal syndrome in children and adults. Prakticheskaya meditsina, 2022, vol. 20, no. 7, pp. 52–56 (in Russ.).
7. Enikeeva Z.M., Akhmadeeva E.N., Agzamova R.F. Clinical course and complications of hemorrhagic fever with renal syndrome in children. Meditsinskiy vestnik Yuga Rossii, 2013, pp. 60–64 (in Russ.).
8. Zhang L., Ma Qs., Zhang Y. et al. Analysis of misdiagnosed cases of hemorrhagic fever with renal syndrome in children: two cases and literature review. BMC Nephrology, 2019, vol. 20 (1), r. 383.
9. Egorov V.B., Valishin D.A., Ushakova I.A. et al. Features of clinical manifestations of hemorrhagic fever with renal syndrome in children and adolescents. Prakticheskaya meditsina, 2012, vol. 7, no. 62, pp. 131–136 (in Russ.).
10. Pozdeeva O.S., Mokhova O.G., Kankasova M.N. et al. Hemorrhagic fever with renal syndrome in children. Prakticheskaya meditsina, 2016, vol. 8, no. 100, pp. 55–59.
11. Iunikhina O.V., Kompanets G.G. Features of hemorrhagic fever with renal syndrome among the child population of Primorsky Krai. Acta Biomed. Sci, 2018, pp. 38–41 (in Russ.).
12. Savenkova N.D. Improving the classifications of acute kidney injury and chronic kidney disease in pediatric nephrology. Nefrologiya, 2018, vol. 22, no. 3, pp. 11–17 (in Russ.).
13. Kidney Diseases Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group. KDIGO Clinical Practice Guide-line for Acute Kidney Injury. Kidney Inter, 2012, vol. 2 (suppl 1), pp. 1–138.
14. Savenkova N.D., Pankov E.A. Unresolved problems of acute kidney injury in children. Nefrologiya, 2015, vol. 19, no. 3, pp. 9–19 (in Russ.).
15. Shakirova V.G., Martynova E.V., Saubanova A.R. et al. Analysis of renal damage markers in patients with hemorrhagic fever with renal syndrome. Prakticheskaya meditsina, 2019, vol. 17, no. 8, pp. 97–102 (in Russ.).
16. Popov A.F., Ivanis V.A., Verkhoturova V.I. et al. Fatal outcome of a case of hemorrhagic fever with renal syndrome. Tikhookeanskiy meditsinskiy zhurnal, 2024, no. 1, pp. 72–74 (in Russ.).