INCREASED PRODUCTION OF NITRIC-OXIDE IN PATIENTS WITH HEMORRHAGIC-FEVER WITH RENAL SYNDROME - RELATION TO ARTERIAL-HYPOTENSION AND TUMOR-NECROSIS-FACTOR

In 15 consecutive subjects hospitalized with nephropathia epidemica, a European form of hemorrhagic fever with renal syndrome, the plasma co ncentrations of nitrate plus nitrite, stable metabolites of nitric oxi de, were determined, From day 3 of onset of disease the concentrations increased, peak levels being reached on days 5 to 7, Maximal plasma c oncentrations of nitrate plus nitrite were correlated to the degree of hypotension (r = -0.64, p = 0.02) and levels of tumor necrosis factor (TNF)-alpha (r = 0.51, p = 0.05) and soluble TNF receptors p55 and p7 5 (r = 0.58, p = 0.03 and r = 0.54, p = 0.04, respectively) but not to levels of interferon-gamma or interleukin-10 (p > 0.05), The results are compatible with the well-known capacity of TNF-alpha to enhance pr oduction of nitric oxide, and suggest that nitric oxide may be of phys iologic importance in hemorrhagic fever with renal syndrome.