Hemorrhagic fever with renal syndrome in children: diagnosis, complications, treatment

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.