Acute renal failure by hantavirus infections

Background: The acute renal failure remains a diagnostic challenge for the clinician. Case reports: Between 1991 and 1996, acute renal failure caused by hantavir us infection was diagnosed in 4 previously healthy male patients. Main symp toms consisted of fever, headache, arthralgia, lumbar and abdominal pain as well as a decline in diuresis. The ultrasonography showed a slight splenom egaly in 2 patients. The clinical chemistry showed elevated serum creatinin e from 2.2 mg/dl to 6.7 mg/dl and thrombocytopenia from 4000 to 150 000/mu l. The examination of the urine showed slight proteinuria and microhematuri a. The kidney biopsy of 1 patient showed a reversible damage of the tubuli. The pathological findings normalized within 3 weeks in 3 patients without need for dialysis. One patient developed a severe clinical course with acut e renal failure and pulmonary edema requiring dialysis. In all patients, th e renal function improved. Conclusion: Hantavirus infection should be considered in acute renal failur e of unknown origin accompanied by fever, arthralgia, lumbar and abdominal pain and thrombocytopenia.