Dengue shock syndrome in renal transplant recipient. Transplant recipient
[Show abstract] [Hide abstract] ABSTRACT: Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.0Comments 15Citations
- "Different renal injuries have been described in dengue patients, such as an increase in serum creatinine, proteinuria, glomerulonephritis, hemolytic-uremic syndrome and acute kidney injury (AKI)4,10,16,37,39. Most cases of AKI have been associated with DHF or DSS6,7,20–23,25,27,34,40, but AKI has also been described in DF13–15,30,31, albeit less commonly. Similarly, rhabdomyolysis with1,5,7,19 and without AKI9,24,28 has been described in dengue patients. "
[Show abstract] [Hide abstract] ABSTRACT: Dengue is a growing public health problem in Pakistan and acute kidney injury (AKI) is one of the least studied complications of dengue virus infection (DVI). The aim of this study was to determine the frequency, severity and predictors of AKI in patients with DVI and to study the impact of AKI on the length of hospital stay and mortality. We retrospectively reviewed medical records of patients aged ≥14 years hospitalized with a primary diagnosis of DVI at Aga Khan University Hospital Karachi between January 2008 and December 2010. Binary logistic regression models were constructed to identify factors associated with the development of AKI and to study the impact of AKI on hospital stays of more than 3 days. Out of 532 patients, AKI was present in 13.3% (71/532). Approximately two-thirds (64.8%) of these patients had mild AKI and a third (35.2%) had moderate to severe AKI. Independent predictors for AKI were male gender [odds ratio (OD) 4.43; 95% CI 1.92-10.23], presence of dengue hemorrhagic and dengue shock syndrome (DSS, OD 2.14; 95% CI 1.06-4.32), neurological involvement (OD 12.08; 95% CI 2.82-51.77) and prolonged activated partial thromboplastin time (aPTT, OD 1.81; 95% CI 1.003-3.26). AKI was associated with a length of stay ≥3 days when compared with those who did not have AKI (OD 2.98; 95% CI 1.66-5.34). Eight patients (11.3%) with AKI died whereas there were no mortalities in patients without AKI (P < 0.001). Only 5 patients (7%) had persistent kidney dysfunction at discharge. AKI in DVI is associated with neurological involvement, prolongation of aPTT, greater length of hospital stay and increased mortality.0Comments 6Citations
- "There are multiple proposed mechanisms for etiopathogenesis of renal impairment in DVI. Dengue causes capillary leakage and loss of fluid from the intravascular compartment leading to shock [9, 10] which may lead to decreased kidney perfusion and acute tubular necrosis. Possible etiological factors for AKI in DF include hypotension with either hemolysis or rhabdomyolysis and shock as reported in various case reports [8, 11– 14]. "
- "Among these patients, 17 had AKI, yielding a percentage of 33.3% of AKI in the patients who died and a percentage of 0.3% of AKI for all DHF cases . Besides these series of patients, there are eight cases of AKI reported in patients with DF891019,20] and 5 cases reported in DHF or DSS [12,14,15,21, 22]. The mortality rate was very high among these patients (five deaths in 13 cases, 38%). "
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