신증후출혈열에서 급성 핍뇨성 신부전의 임상양상 및 예측인자

Abstract

Background: Hemorrhagic fever with renal syndrom (HFRS), caused by hantaviruses infection, develops acute renal failure (ARF) of variable severity. Because oliguric ARF is severe form, associated with more complications and hemodialysis requirement, we investigated the characteristics and predictors of oliguric ARF in HFRS patients.

Methods: From Oct. 2000 to Dec. 2004, Sixty one patients, admitted at Armed Forces Capital Hospital, with typical clinical feature of HFRS and serologically confirmed hantaan virus infection were studied. The medical records were reviewed retrospectively and patients were categorized into oliguric and nonoliguric ARF group according to urine output (<400 mL/24h). We compared clinical symptoms, signs, laboratory findings and clinical course between two groups.

Results: Twenty four patients (39.3%) categorized into oliguric ARF group and 37 patients (60.7%) into nonoliguric ARF group. There were no significant differences in age, duration from onset to hospital, clinical symptoms and signs. But, leukocyte count, platelet count, serum sodium, potassium, creatinine, AST, ALT on admission, maximun leukocyte count and minimum platelet count showed significant differences. Maximun serum creatinine was 10.8+/-2.4 mg/dL in oliguric ARF, 4.7+/-2.1 mg/dL in nonoliguric ARF (p<0.001). Hemodialysis was required with 21 patients (87.5%) in oliguric ARF and 2 patients (5.4%) in nonoliguric ARF. Risk of oliguric ARF in HFRS increased when laboratory findings on admission were as follows; leukocyte count>or=15x10(9)/L (RR 2.36 [95% CI 1.19-4.67]), platelet countor=110IU/L (RR 3.10 [95% CI 1.43-6.73]) and microscopic hematuria>or=5/HPF (RR 3.68 [95% CI 1.24-10.91]).

Conclusions: HFRS patients with oliguric ARF showed more elevation of serum creatinine and more requirement of hemodialysis than HFRS patients with non-oliguric ARF and leukocyte count, platelet count, AST and microscopic hematuria on admission were helpful to predict the development of oliguric ARF in HFRS patients.