atrial-natriuretic-factor and Hemorrhagic-Fever-with-Renal-Syndrome

A 23-year-old man developed acute renal failure (ARF) due to hemorrhagic fever with renal syndrome (HFRS). The patient also developed anterior hypopituitarism as a complication of HFRS. The patient's oliguric phase was very much prolonged for over 10 days before the diuresis began. The urine output during the oliguric phase was near anuric (< 50 ml/day). Interestingly, the patient began to diurese just after the institution of glucocorticoid and thyroid hormone replacement therapy. The plasma atrial natriuretic polypeptide went up to a smaller peak (150.0 pg/ml) at the onset of diuresis compared with 15 other patients (292.4 +/- 190.4 pg/ml) who did not develop anterior hypopituitarism. The delayed onset of diuresis and smaller increase of plasma ANP may have a causal relationship with the patient's hypopituitarism.

Topics: Acute Kidney Injury; Adult; Atrial Natriuretic Factor; Diuresis; Hemorrhagic Fever with Renal Syndrome; Humans; Hypopituitarism; Male; Pituitary Gland, Anterior; Radioimmunoassay; Renin

Nephropathia epidemica (NE) with renal syndrome, caused by the Puumala-virus, is manifested clinically by the triad of fever, hemorrhage and renal failure. We observed raised plasma concentrations of endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) in 23 patients during the acute phase of NE. They all developed transient renal failure and all displayed characteristics of NE, also verified by a rapid IgG antibody test. Blood pressure was normal or low in all subjects during the acute phase of the disease. Plasma ET-1 and ANP levels returned to normal following recovery one month later. The cause of increased ET-1 synthesis in NE remains unknown. It may be related to vascular damage or extravasation of blood. ET-1 may participate in the pathogenesis of acute renal failure of NE. Raised plasma ANP levels were most likely caused by fluid retention during the acute phase of NE. However, high levels of circulating ET-1 might have contributed to increased release of ANP.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Endothelins; Female; Hemorrhagic Fever with Renal Syndrome; Humans; Male; Middle Aged; Orthohantavirus

Korean hemorrhagic fever (KHF) is an epidemic viral disease characterized by high fever, hemorrhagic tendency and renal failure, and by hemorrhages of right atrium and renal medulla as well as necrosis of anterior hypophysis. Plasma immunoreactive atrial natriuretic peptide (irANP) levels of 15 patients in the oliguric phase was 94.8 +/- 8.4 pg/ml (mean +/- SEM), 80% higher than of the normal control group (53.0 +/- 4.7 pg/ml; n = 28). In the diuretic phase it declined to 63.7 +/- 5.3 pg/ml (n = 26). Plasma renin activity (PRA) in the oliguric phase was 19.0 +/- 1.3 ng AI/ml/h, and in the diuretic phase 5.3 +/- 0.9 ng AI/ml/h, significantly higher than the control value (2.5 +/- 0.1 ng AI/ml/h). Elevations of irANP and PRA were not correlated in each group. Also systemic blood pressure as well as heart beats were significantly increased in the oliguric phase. These findings suggest that the increased irANP may have resulted from increased circulatory volume and that the ANP secretory process may not be affected by the disease.

Topics: Acute Kidney Injury; Atrial Natriuretic Factor; Blood Pressure; Diuresis; Hemorrhagic Fever with Renal Syndrome; Humans; Orthohantavirus; Radioimmunoassay; Renin