Aceituno Diana, Fica Alberto, Fasce Rodrigo, Andrade Winston, Díaz Carolina
Escuela de Medicina, Universidad de los Andes, Chile.
Servicio de Infectología, Hospital Militar, Santiago, Chile.
Rev Chilena Infectol. 2017 Feb;34(1):81-86. doi: 10.4067/S0716-10182017000100013.
Acute renal failure (ARF) requiring hemodialysis is not common among patients affected by influenza. We report two unvaccinated adult patients with smoking habit, which were admitted with severe influenza A H1N1pdm09 that evolved with shock and required mechanical ventilation. Both patients developed progressive renal failure with oliguria/anuria, associated with urinary of inflammatory sediment with proteinuria, microhematuria and in one case also with hypocomplementemia, suggesting acute glomerulonephritis. Renal replacement therapy (RRT) was required in both cases. In one patient, who died of late complications, sequencing of the HA1 segment revealed the previously described D222N mutation associated to severe cases. ARF with RRT appears to be an uncommon complication of patients hospitalized for influenza A H1N1pdm09 and may be secondary to acute glomerulonephritis.
需要进行血液透析的急性肾衰竭（ARF）在流感患者中并不常见。我们报告了两名有吸烟习惯的未接种疫苗的成年患者，他们因严重的甲型H1N1pdm09流感入院，病情发展为休克并需要机械通气。两名患者均出现进行性肾衰竭，伴有少尿/无尿，伴有炎性尿沉渣、蛋白尿、镜下血尿，其中一例还伴有补体低下，提示急性肾小球肾炎。两例均需要肾脏替代治疗（RRT）。在一名死于晚期并发症的患者中，对HA1片段进行测序发现了先前描述的与重症病例相关的D222N突变。ARF合并RRT似乎是甲型H1N1pdm09流感住院患者中不常见的并发症，可能继发于急性肾小球肾炎。
