Abstract
Dengue virus infection (DVI)/dengue hemorrhagic fever (DHF) is a common febrile illness with a variety of severities. The mortality rate is high in dengue shock syndrome (DSS), caused by circulatory failure due to plasma leakage resulting in multi-organ failure. However, acute kidney injury (AKI) is rarely reported. In areas of endemic DVI, the prevalence of AKI due to DVI has been reported to be as high as 6.0 % in children with AKI, and 0.9 % in children with DVI who were admitted to a hospital. The mechanism of AKI in DVI is not clear. It may result from (a) direct injury as in other infectious diseases, (b) an indirect mechanism such as via the immune system, since DHF is an immunological disease, or (c) hypotensive DSS, leading in turn to reduced renal blood supply and renal failure. The mortality rates of DF/DHF, DSS and DHF/DSS-related AKI are <1 %, 12-44 %, and >60 %, respectively. Kidney involvement is not actually that rare, but is under-recognized and often only reported when microscopic hematuria, proteinuria, electrolyte imbalance, or even AKI is found. The prevalence of proteinuria and hematuria has been reported as high as 70-80 % in DVI. A correct diagnosis depends on basic investigations of kidney function such as urinalysis, serum creatinine and electrolytes. Although DVI-related renal involvement is treated supportively, it is still important to make an early diagnosis to prevent AKI and its complications, and if AKI does occur, dialysis may be required. Fortunately, in patients who recover, kidney function usually completely recovers as well.
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Koh BK, Ng LC, Kita Y, Tang CS, Ang LW, Wong KY, James L, Goh KT (2008) The 2005 dengue epidemic in Singapore: epidemiology, prevention and control. Ann Acad Med Singapore 37:538–545
Pinazo MJ, Munoz J, Betica L, Maretic T, Zekan S, Avsic-Zupanc T, Sequeira E, Trilla A, Gascon J (2008) Imported dengue hemorrhagic fever, Europe. Emerg Infect Dis 14:1329–1330
Bulugahapitiya U, Siyambalapitiya S, Seneviratne SL, Fernando DJ (2007) Dengue fever in travellers: a challenge for European physicians. Eur J Intern Med 18:185–192
Teixeira MG, Costa Mda C, Barreto F, Barreto ML (2009) Dengue: twenty-five years since reemergence in Brazil. Cad Saude Publica 25(Suppl 1):S7–18
Alejandria MM (2009) Dengue haemorrhagic fever or dengue shock syndrome in children. Clin Evid (online)
Undurraga EA, Betancourt-Cravioto M, Ramos-Castaneda J, Martinez-Vega R, Mendez-Galvan J, Gubler DJ, Guzman MG, Halstead SB, Harris E, Kuri-Morales P, Tapia-Conyer R, Shepard DS (2015) Economic and disease burden of dengue in Mexico. PLoS Negl Trop Dis 9:e0003547
Morens DM (2009) Dengue fever and dengue hemorrhagic fever. Pediatr Infect Dis J 28:635–636
Karakus A, Banga N, Voorn GP, Meinders AJ (2007) Dengue shock syndrome and rhabdomyolysis. Neth J Med 65:78–81
Rigau-Perez JG, Clark GG, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV (1998) Dengue and dengue haemorrhagic fever. Lancet 352:971–977
Anderson KB, Chunsuttiwat S, Nisalak A, Mammen MP, Libraty DH, Rothman AL, Green S, Vaughn DW, Ennis FA, Endy TP (2007) Burden of symptomatic dengue infection in children at primary school in Thailand: a prospective study. Lancet 369:1452–1459
Gulati S, Maheshwari A (2007) Atypical manifestations of dengue. Trop Med Int Health 12:1087–1095
Halstead SB (2008) Dengue: overview and history. In: Halstead SB (ed) Dengue tropical medicine: science and practice. Imperial College Press, London, pp 1–28
Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, Moyes CL, Farlow AW, Scott TW, Hay SI (2012) Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 6:e1760
Anonymous (2009) Dengue guidelines for diagnosis, treatment, prevention and control. World Health Organization, Geneva
World Health Organization (1997) Dengue hemorrhagic fever: diagnosis, treatment, prevention and control. World Health Organization, Geneva
Kanakaratne N, Wahala WM, Messer WB, Tissera HA, Shahani A, Abeysinghe N, de-Silva AM, Gunasekera M (2009) Severe dengue epidemics in Sri Lanka, 2003–2006. Emerg Infect Dis 15:192–199
Gunther J, Ramirez-Palacio LR, Perez-Ishiwara DG, Salas-Benito JS (2009) Distribution of dengue cases in the state of Oaxaca, Mexico, during the period 2004–2006. J Clin Virol 45:218–222
Wang CC, Lee IK, Su MC, Lin HI, Huang YC, Liu SF, Wu CC, Lin MC (2009) Differences in clinical and laboratory characteristics and disease severity between children and adults with dengue virus infection in Taiwan, 2002. Trans R Soc Trop Med Hyg 103:871–877
Teixeira MG, Costa MC, Coelho G, Barreto ML (2008) Recent shift in age pattern of dengue hemorrhagic fever, Brazil. Emerg Infect Dis 14:1663
Hemungkorn M, Thisyakorn U, Thisyakorn C (2007) Dengue infection: a growing global health threat. Biosci Trends 1:90–96
Wichmann O, Hongsiriwon S, Bowonwatanuwong C, Chotivanich K, Sukthana Y, Pukrittayakamee S (2004) Risk factors and clinical features associated with severe dengue infection in adults and children during the 2001 epidemic in Chonburi, Thailand. Trop Med Int Health 9:1022–1029
Lee IK, Liu JW, Yang KD (2009) Clinical characteristics, risk factors, and outcomes in adults experiencing dengue hemorrhagic fever complicated with acute renal failure. Am J Trop Med Hyg 80:651–655
Potts JA, Rothman AL (2008) Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health 13:1328–1340
Settergren B, Ahlm C, Alexeyev O, Billheden J, Stegmayr B (1997) Pathogenetic and clinical aspects of the renal involvement in hemorrhagic fever with renal syndrome. Ren Fail 19:1–14
Siamopoulos K, Antoniades A, Acritidis N, Constantopoulos S, Tsianos E, Papapanagiotou I, Moutsopoulos HM (1985) Outbreak of haemorrhagic fever with renal syndrome in Greece. Eur J Clin Microbiol 4:132–134
Guang MY, Liu GZ, Cosgriff TM (1989) Hemorrhage in hemorrhagic fever with renal syndrome in China. Rev Infect Dis 11(Suppl 4):S884–S890
Lee HW, van der Groen G (1989) Hemorrhagic fever with renal syndrome. Prog Med Virol 36:62–102
Han D, Liu Z, Han Q, Li Z, Zhang G, Qiu J, Lou S, Li N, Wang Y, Li M (2011) Acute kidney injury in patients with hemorrhagic fever with renal syndrome caused by Hantaan virus: comparative evaluation by RIFLE and AKIN criteria. Vector Borne Zoonotic Dis 11:723–730
Gledovic ZB, Jeknic AS, Grgurevic AD, Rakocevic BB, Bozovic BR, Mugosa BV (2008) Hemorrhagic fever with renal syndrome in Montenegro. Jpn J Infect Dis 61:386–387
Sion ML, Hatzitolios AI, Armenaka MC, Toulis EN, Kalampalika D (2002) Mikoudi KD (2002) Acute renal failure caused by leptospirosis and Hantavirus infection in an urban hospital. Eur J Intern Med 13:264–268
Matthaeus T, Fries J, Weber M, Schulze-Lohoff E (2004) Glomerular-type proteinuria in hantavirus nephritis. Med Klin (Munich) 99:223–227
Futrakul P, Poshyachinda V, Mitrakul C, Kun-Anake C, Boonpucknavig V, Boompucknavig S, Bhamarapravati N (1973) Renal involvement and reticulo-endothelial-system clearance in dengue hemorrhagic fever. J Med Assoc Thai 56:33–39
Jactice F (2008) Clinical features of dengue. In: Halstead SB (ed) Dengue tropical medicine: science and practice. Imperial College Press, London, pp 171–191
Lee IK, Liu JW, Yang KD (2005) Clinical characteristics and risk factors for concurrent bacteremia in adults with dengue hemorrhagic fever. Am J Trop Med Hyg 72:221–226
Wang CC, Liu SF, Liao SC, Lee IK, Liu JW, Lin AS, Wu CC, Chung YH, Lin MC (2007) Acute respiratory failure in adult patients with dengue virus infection. Am J Trop Med Hyg 77:151–158
Hommel D, Talarmin A, Reynes JM, Hulin A (1999) Acute renal failure associated with dengue fever in French Guiana. Nephron 83:183
Khan NA, Azhar EI, El-Fiky S, Madani HH, Abuljadial MA, Ashshi AM, Turkistani AM, Hamouh EA (2008) Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Acta Trop 105:39–44
Chaturvedi UC, Nagar R (2008) Dengue and dengue haemorrhagic fever: Indian perspective. J Biosci 33:429–441
Ooi EE, Gubler DJ (2009) Dengue in Southeast Asia: epidemiological characteristics and strategic challenges in disease prevention. Cad Saude Publica 25(Suppl 1):S115–S124
Lombardi R, Yu L, Younes-Ibrahim M, Schor N, Burdmann EA (2008) Epidemiology of acute kidney injury in Latin America. Semin Nephrol 28:320–329
Lumpaopong A, Kaewplang P, Watanaveeradej V, Thirakhupt P, Chamnanvanakij S, Srisuwan K, Pongwilairat N, Chulamokha Y (2010) Electrolyte disturbances and abnormal urine analysis in children with dengue infection. Southeast Asian J Trop Med Public Health 41:72–76
Vachvanichsanong P, McNeil E (2015) Electrolyte disturbance and kidney dysfunction in dengue viral infection. Southeast Asian J Trop Med Public Health 46(Supplement 1):108–117
Loghman-Adham M (1998) Evaluating proteinuria in children. Am Fam Physician 58(1145–1152):1158–1159
Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A, Ingelfinger J (2000) Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics 105:1242–1249
Vasanwala FF, Puvanendran R, Ng JM, Suhail SM (2009) Two cases of self-limiting nephropathies secondary to dengue haemorrhagic fever. Singapore Med J 50:e253–e255
Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E (2006) Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 118:e786–e791
Laoprasopwattana K, Pruekprasert P, Dissaneewate P, Geater A, Vachvanichsanong P (2010) Outcome of dengue hemorrhagic fever-caused acute kidney injury in Thai children. J Pediatr 157:303–309
Mendez A, Gonzalez G (2003) Dengue haemorrhagic fever in children: ten years of clinical experience. Biomedica 23:180–193
Kuo MC, Lu PL, Chang JM, Lin MY, Tsai JJ, Chen YH, Chang K, Chen HC, Hwang SJ (2008) Impact of renal failure on the outcome of dengue viral infection. Clin J Am Soc Nephrol 3:1350–1356
Bunnag T, Kalayanarooj S (2011) Dengue shock syndrome at the emergency room of Queen Sirikit National Institute of Child Health. Bangkok, Thailand, J Med Assoc Thai 94(Suppl 3):S57–S63
Mehra N, Patel A, Abraham G, Reddy YN, Reddy YN (2012) Acute kidney injury in dengue fever using Acute Kidney Injury Network criteria: incidence and risk factors. Trop Doct 42:160–162
Khalil MAMSS, Chaudry MA, Maqbool B, Khalil Z, Tan J, Yaqub S, Hussain SA (2012) Acute kidney injury in dengue virus infection. Clin Kidney J 5:5
Basu G, Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas K, Abraham AM, John GT (2011) Acute kidney injury in tropical acute febrile illness in a tertiary care centre—RIFLE criteria validation. Nephrol Dial Transplant 26:524–531
Boonpucknavig V, Bhamarapravati N, Boonpucknavig S, Futrakul P, Tanpaichitr P (1976) Glomerular changes in dengue hemorrhagic fever. Arch Pathol Lab Med 100:206–212
Lima EQ, Nogueira ML (2008) Viral hemorrhagic fever-induced acute kidney injury. Semin Nephrol 28:409–415
Gunasekera HH, Adikaram AV, Herath CA, Samarasinghe HH (2000) Myoglobinuric acute renal failure following dengue viral infection. Ceylon Med J 45:181
Lim M, Goh HK (2005) Rhabdomyolysis following dengue virus infection. Singapore Med J 46:645–646
Davis JS, Bourke P (2004) Rhabdomyolysis associated with dengue virus infection. Clin Infect Dis 38:e109–e111
Boonpucknavig V, Soontornniyomkij V (2003) Pathology of renal diseases in the tropics. Semin Nephrol 23:88–106
Nair VRUD (2005) Acute renal failure in dengue fever in the absence of bleeding manifestations or shock. Infect Dis Clin Pract 13:2
George R, Liam CK, Chua CT, Lam SK, Pang T, Geethan R, Foo LS (1988) Unusual clinical manifestations of dengue virus infection. Southeast Asian J Trop Med Public Health 19:585–590
Wiersinga WJ, Scheepstra CG, Kasanardjo JS, de Vries PJ, Zaaijer H, Geerlings SE (2006) Dengue fever-induced hemolytic uremic syndrome. Clin Infect Dis 43:800–801
Thisyakorn U, Thisyakorn C (1994) Dengue infection with unusual manifestations. J Med Assoc Thai 77:410–413
Kuo MC, Chang JM, Lu PL, Chiu YW, Chen HC, Hwang SJ (2007) Difficulty in diagnosis and treatment of dengue hemorrhagic fever in patients with chronic renal failure: report of three cases of mortality. Am J Trop Med Hyg 76:752–756
Gibbons RV, Vaughn DW (2002) Dengue: an escalating problem. BMJ 324:1563–1566
Nimmannitya S, Thisyakorn U, Hemsrichart V (1987) Dengue haemorrhagic fever with unusual manifestations. Southeast Asian J Trop Med Public Health 18:398–406
Lima EQ, Gorayeb FS, Zanon JR, Nogueira ML, Ramalho HJ, Burdmann EA (2007) Dengue haemorrhagic fever-induced acute kidney injury without hypotension, haemolysis or rhabdomyolysis. Nephrol Dial Transplant 22:3322–3326
Suzuki S, Kitazawa T, Ota Y, Okugawa S, Tsukada K, Nukui Y, Hatakeyama S, Yamaguchi D, Matsuse S, Ishii T, Matsubara T, Yamauchi C, Ota S, Yahagi N, Fukayama M, Koike K (2007) Dengue hemorrhagic shock and disseminated candidiasis. Intern Med 46:1043–1046
Thaha M, Pranawa Yogiantoro M, Tanimoto M, Tomino Y (2008) Acute renal failure in a patient with severe malaria and dengue shock syndrome. Clin Nephrol 70:427–430
Guzman MG, Alvarez M, Rodriguez R, Rosario D, Vazquez S, Vald s L, Cabrera MV, Kouri G (1999) Fatal dengue hemorrhagic fever in Cuba, 1997. Int J Infect Dis 3:130–135
Jessie K, Fong MY, Devi S, Lam SK, Wong KT (2004) Localization of dengue virus in naturally infected human tissues, by immunohistochemistry and in situ hybridization. J Infect Dis 189:1411–1418
Guzman MG, Kouri G (2002) Dengue: an update. Lancet Infect Dis 2:33–42
Coffey LL, Mertens E, Brehin AC, Fernandez-Garcia MD, Amara A, Despres P, Sakuntabhai A (2009) Human genetic determinants of dengue virus susceptibility. Microbes Infect 11:143–156
Chan JC, Williams DM, Roth KS (2002) Kidney failure in infants and children. Pediatr Rev 23:47–60
Nisalak A, Endy TP, Nimmannitya S, Kalayanarooj S, Thisayakorn U, Scott RM, Burke DS, Hoke CH, Innis BL, Vaughn DW (2003) Serotype-specific dengue virus circulation and dengue disease in Bangkok, Thailand from 1973 to 1999. Am J Trop Med Hyg 68:191–202
Smart K, Safitri I (2009) Evidence behind the WHO guidelines: hospital care for children: what treatments are effective for the management of shock in severe dengue? J Trop Pediatr 55:145–148
Ong A, Sandar M, Chen MI, Sin LY (2007) Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore. Int J Infect Dis 11:263–267
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Vachvanichsanong, P., Thisyakorn, U. & Thisyakorn, C. Dengue hemorrhagic fever and the kidney. Arch Virol 161, 771–778 (2016). https://doi.org/10.1007/s00705-015-2727-1
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DOI: https://doi.org/10.1007/s00705-015-2727-1