Hemorrhagic fever with renal syndrome: clinical, pathogenetic and therapeutic aspects
Vera F. Pavelkina
Yuliya G. Uskova
Introduction: The republic of Mordovia (RM) is an active natural focus of hemorrhagic fever with renal syndrome (HFRS). The incidence of HFRS ranges from 10 to 40 cases per 100 000 people, i.e. exceeds the average Russian rate. The relevance of HFRS is determined by the involvement of many organs and systems in the pathological process. The intoxication syndrome (IS) takes a leading place in the pathogenesis of the disease. The development of IS is associated with both the phenomenon of viremia, and the accumulation of endogenous toxins in the body. Despite the large number of recommendations, the problem of IS correction is not completely solved. Antiviral drugs are not applicable in connection with a short period of viremia. Therefore, the basis of treatment is pathogenetic therapy. The purpose of research is to study the clinical, epidemiological and therapeutic aspects of the medium degree HFRS.
Materials and Methods: In the course of the study, the patients of two groups were examined: the first group (comparison group, 35 patients) received basal therapy; the second group (primary group, 25 patients) received a dropwise preparation of remaxol (400 ml) for 7 days intravenously. The control group consisted of 30 healthy people of a similar age group. The clinical features of the disease in the Republic of Mordovia, as well as objective indicators were observed. Urea, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), medium-weight molecules (MWM), circulating immune complexes (CIC), total, effective concentration and binding capacity of albumin (TCA, ECA, BCA), and toxicity index (TI) were studied.
Results: The infection was mainly in rural areas (78.3 %). Despite the c yclicity of the course, there was no clearly defined period of oliguria in the HFRS clinic (in 22 %), polyuria in 27 % of cases. Hepatomegaly is combined with a change in functional liver samples. The pathological changes indicate the presence of IS, which persists after the basic therapy, which pathogenetically substantiates the necessity of using agents with a detoxification and membrane-protective mechanism of action. The use of remaxol in the complex therapy of HFRS reduces the severity of clinical manifest tations of IS, shortens the oliguric and polyuric periods of the disease, contributes to a decrease in the laboratory indicators of IS and hepatic dysfunction.
Discussion and Conclusions: The incidence in the Republic of Mordovia remains high. The cyclicity of HFRS was not always noted in the clinic. The infectious process is accompanied by the development of expressed IS and cytolytic hepatocytes. Normalization of the studied homeostasis indices does not occur to the period of clinical recovery of patients. Remaxol as part of the complex therapy reduces the severity of clinical symptoms of IS and its laboratory indicators. All this things confirm the detoxifying and hepatoprotective efficacy of the drug and indicate the promise of remaxol in clinical practice.
Keywords: hemorrhagic fever with renal syndrome, epidemiology, clinic, intoxication syndrome, liver, treatment, remaxol
For citation: Pavelkina V. F., Uskova Yu. G. Hemorrhagic fever with renal syndrome: clinical, pathogenetic and therapeutic aspects. Vestnik Mordovskogo universiteta = Mordovia University Bulletin. 2017; 27(3):315–329. DOI: 10.15507/0236- 2910.027.201703.315-329
Contribution of the co-authors: V. F. Pavelkina: scientific guidance, developing the concept and methods of the study, critical review of relevant literature, editing the final text; Yu. G. Uskova: analysis of relevant literature and clinical materials, patient care on the topic of research, statistical data processing, writing the draft, computer formatting.
This work is licensed under a Creative Commons Attribution 4.0 License.