Stockmann M, Stöffler-Meilicke M, Schwarz A, Pohly M, Scherübl H
Medizinische Klinik I Gastroenterologie, Infektiologie und Rheumatologie, Germany.
Dtsch Med Wochenschr. 2002 Mar 15;127(11):557-60. doi: 10.1055/s-2002-22047.
Puumala virus infection (nephropathia epidemica) as different diagnosis of acute renal failure.
A 34-year old patient presented in reduced status with a sudden onset of fever, headache, backpain, abdominal pain, mild diarrhea, nausea with vomiting, and blurred vision. Within a few days an acute renal failure developed.
On admittance there was thrombocytopenia of 27/nl, CRP of 109 mg/l and proteinuria of 5 g/l, moderate glucosuria and erythrocyturia of 250/microliter. Renal biopsy showed acute hemorrhagic interstitial nephritis. DIAGNOSIS, THERAPY AND FOLLOW UP: Diagnosis of nephropathia epidemica was proven by puumala-virus IgM- and later IgG-antibodies. Hantaan-antibodies were negative. Maximum serum creatinine of 640 micromol/l and urea of 30.5 mmol/l developed on the 5(th) day after admission. Without specific therapy the patient recovered fast and there were no persisting abnormalities during a 2-year follow up.
In young patients with acute renal failure of unknown origin with the above symptoms hantavirus-infection with the subtypes puumala and dobrava should be considered in Central Europe.
普马拉病毒感染（流行性肾病）作为急性肾衰竭的不同诊断。
一名34岁患者，病情逐渐加重，突然出现发热、头痛、背痛、腹痛、轻度腹泻、恶心伴呕吐及视力模糊。数天内发展为急性肾衰竭。
入院时血小板计数为27/微升，C反应蛋白为109毫克/升，蛋白尿为5克/升，中度糖尿，红细胞尿为250/微升。肾活检显示急性出血性间质性肾炎。诊断、治疗及随访：通过普马拉病毒IgM抗体及随后的IgG抗体证实为流行性肾病。汉坦病毒抗体为阴性。入院后第5天血清肌酐最高达640微摩尔/升，尿素达30.5毫摩尔/升。未经特殊治疗，患者恢复迅速，在2年随访期间无持续异常。
在中欧地区，对于病因不明且有上述症状的急性肾衰竭年轻患者，应考虑感染普马拉和多布拉瓦亚型汉坦病毒。
