PROSPECTIVE-STUDY OF TETANUS-INDUCED ACUTE RENAL DYSFUNCTION - ROLE OF ADRENERGIC OVERACTIVITY

To assess the mechanisms related to tetanus-induced acute renal failur e (ARF), 30 patients with tetanus had their renal function prospective ly studied and factors possibly related to renal changes were evaluate d during four weeks of hospitalization. Fifty percent of these patient s had a glomerular filtration rate (GFR) less than or equal to 50 mi/m in in the first or second week of hospitalization (Group I) and 50% ha d a GFR > 50 ml/min throughout the entire hospitalization period (Grou p II). Age, gender, tetanus incubation time and tetanus onset time, ho spitalization time, use of nephrotoxic drugs, need for mechanical vent ilation with intermittent positive pressure, and presence of systemic infection were similar in both groups. None of the patients presented with oliguria. Autonomic nervous system (ANS) overactivity, characteri zed by intense variations in systolic and diastolic blood pressure, by increased heart rate and elevated urinary metanephrine excretion, was higher in Group I compared with Group LI. Plasma renin activity, seru m creatinephosphokinase levels, and myoglobinuria were not significant ly different between the two groups. These results strongly suggest th at tetanus-induced ARF has a high prevalence, is characterized by earl y onset, and is probably related to ANS overactivity.