deamino-arginine-vasopressin and Acute-Kidney-Injury

The clinical features, course and outcome of hantavirus infection is highly variable. Symptoms of the central nervous system may occur, but often present atypically and diagnostically challenging. Even though the incidence of hantavirus infection is increasing worldwide, this case is the first to describe diabetes insipidus centralis as a complication of hantavirus infection in the Western world.. A 49-year old male presenting with severe headache, nausea and photophobia to our neurology department was diagnosed with acute haemorrhage in the pituitary gland by magnetic resonance imaging. In the following days, the patient developed severe oliguric acute kidney failure. Diagnostic workup revealed a hantavirus infection, so that the pituitary haemorrhage resulting in hypopituitarism was seen as a consequence of hantavirus-induced hypophysitis. Under hormone replacement and symptomatic therapy, the patient's condition and kidney function improved considerably, but significant polyuria persisted, which was initially attributed to recovery from kidney injury. However, water deprivation test revealed central diabetes insipidus, indicating involvement of the posterior pituitary gland. The amount of urine production normalized with desmopressin substitution.. Our case report highlights that neurological complications of hantavirus infection should be considered in patients with atypical clinical presentation.

Topics: Acute Kidney Injury; Antibodies, Viral; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Follow-Up Studies; Hantavirus Infections; Hormone Replacement Therapy; Humans; Hypophysitis; Hypopituitarism; Magnetic Resonance Imaging; Male; Middle Aged; Orthohantavirus; Phylogeny; Polymerase Chain Reaction; Polyuria; Treatment Outcome

A significant percentage of acute renal failure patients may benefit from a diagnostic renal biopsy, but this procedure carries an unacceptable risk of hemorrhagic complications. We have previously shown that red cell transfusions and 1-deamino-8-D-arginine vasopressin (DDAVP) are effective in managing uremic bleeding. We now report the results of giving washed red cell transfusions or DDAVP to 9 patients with uremia due to acute renal failure to improve hemostasis and allow a diagnostic renal biopsy. All patients admitted to the study had prolonged bleeding time (BT), ie, more than 10 minutes, and our procedure shortened BT in all cases, though in two patients BT after the therapeutic procedure was still longer than normal. In these two, biopsy was not performed. The seven patients whose BT became normal underwent percutaneous biopsy. Only minor clinical complications were registered. Computerized tomography (CT) revealed an incidence of perirenal hematomas comparable to that usually reported in patients with normal or slightly depressed renal function who undergo renal biopsy. Our findings indicate that red cell transfusions or DDAVP can temporarily restore hemostasis, allowing a diagnostic percutaneous biopsy in patients with acute renal failure.

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Biopsy, Needle; Bleeding Time; Blood Transfusion; Deamino Arginine Vasopressin; Erythrocyte Transfusion; Female; Hematocrit; Hematuria; Humans; Male; Middle Aged; Platelet Function Tests

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Biopsy; Bleeding Time; Blood Transfusion; Deamino Arginine Vasopressin; Female; Hemorrhage; Humans; Kidney; Male; Middle Aged; Platelet Function Tests

The treatment of the haemorrhagic tendency of acute renal failure remains unsatisfactory. To investigate a potential new therapy, 8 patients with acute renal failure and prolonged bleeding times received an infusion of 1-deamino-8-d-arginine vasopressin (0.4 microgram/kg). This resulted in significant shortening of the bleeding time at 1 and 2 hours post-infusion. The beneficial effect on bleeding time had largely disappeared by 8 hours. Pre-infusion Factor VIII activities were either within the normal range or mildly increased and a tendency to further elevation was noted post-DDAVP. In contrast, no alteration in platelet count or haematocrit was observed. No adverse effects were reported, and no significant change in heart rate, blood pressure or plasma osmolarity was noted.

Topics: Acute Kidney Injury; Arginine Vasopressin; Bleeding Time; Deamino Arginine Vasopressin; Factor VII; Female; Hemorrhagic Disorders; Humans; Male; Platelet Function Tests; Time Factors

The treatment of the bleeding diathesis of renal failure remains unsatisfactory. 1-Deamino-8-D-arginine vasopressin (DDAVP) has recently been shown to shorten the prolonged bleeding time of renal failure and may as a result diminish the risk of clinical hemorrhage. We describe 2 cases where DDAVP was used successfully in the management of hemorrhage in the setting of renal insufficiency.

Topics: Acute Kidney Injury; Aged; Arginine Vasopressin; Bleeding Time; Deamino Arginine Vasopressin; Female; Hemorrhagic Disorders; Humans; Kidney Failure, Chronic; Male