Download Preferential bone mineral loss in postmenopausal dialysed women?

Nephrol Dial Transplant (1996) 11. 748-753
Nephrology
Dialysis
Transplantation
Letters
Ubiquity of Hantaan virus infection with renal syndrome
essential to undertake serological studies to determine the
underlying aetiology.
Sir,
Haemorrhagic fever with renal syndrome was first observed
in Russia in 1932 but since then has been reported from
countries bordering the Baltic Sea and Pacific Ocean as well
as from Western and Eastern Europe [1-5]. Three viruses
have been detected: (1) Hantaan virus, Korean haemorrhagic
fever; (2) Puumala virus, nephropathia epidemica; (3) Seoul
virus, haemorrhagic fever with renal syndrome. The incubation period of Hantaan virus is between 5 and 42 days and
clinically the infection is characterized by an acute illness
with fever and chills, conjunctival injection, prostration,
anorexia, vomiting, abdominal pain, with haemorrhagic complications from the third day. During the acute phase mild
to acute renal failure may develop and persist for several
weeks. In the 60s the mortality was 7-15% whereas now,
with earlier diagnosis and improved intensive care it has
declined to less than 5%.
We report here our experience of 10 patients (8 male, 2
female aged 37 + 4 years) seen in our Department of
Nephrology in a 3-year period from October 1987 to July
1990. The diagnosis of Hantaan virus infection was made by
indirect immunofluorescence and an ELISA test. In three
patients a renal biopsy was performed.
Pyrexia, weakness, headache, and conjunctival injection
were present in all patients. Haemorrhagic complications
were present in some: epistaxis (2), petechiae (5), ecchymoses
(4), melaena (2), and genital bleeding (1). Symptoms similar
to other viral diseases were present, catarrh, meningeal signs,
and vomiting. Clinical signs of involvement of the central
nervous system were present, hypotension, bradycardia,
neurological disorders, and blurred vision. Leukocytosis was
a finding common to the whole group (13 500-30 000/mm3),
serum IgA was elevated in one patient (4.12 g/1) and IgM
in another (2.3 g/1). Serum C3 was decreased in three and
slightly increased liver enzymes (ALAT and ASAT) were
also present in three. Microscopic haematuria was only
absent in one. Anuria was present in seven patients and
oliguria in the remaining three, haemodialysis was required
in seven patients. Non-nephrotic proteinuria and decreased
serum sodium was present in eight. Renal biopsy confirmed
interstitial nephritis in two patients whilst the third had a
diffuse proliferative glomerulonephritis. Mild tubular parenchymal degeneration and intensive lymphocytic infiltration
were common to all three biopsies. The lymphocytic infiltrate
was recognized as T cells in 70% and helper T cells in 40%.
The outcome was favourable in eight patients with complete restoration of renal function. One patient died during
the polyuric phase of the illness and an accompanying
brucellosis with cardiac involvement was diagnosed. The
remaining patient, with the most marked interstitial infiltration, developed chronic renal failure.
This report confirms the fact that haemorrhagic fever in
the Republic of Macedonia is usually associated with infection with Hantaan virus. It is now recognized that Hantaan
virus is ubiquitous, having been recently reported from areas
where it had been not previously recognized [1-3,5]. The
importance of our report is to draw attention to the fact
that when clinical features suggest haemorrhagic fever, it is
Department of Nephrology,
Faculty of Medicine,
Vodnjanska 17
91000 Skopje, Republic of Macedonia
M. Polenakovic
L. Grcevska
1. Editorial. Muroid nephropathies. Lancet 1982; 2: 1375-1377
2. Davies EA, Rooney PJ, Coyle PV et at. Hantavirus and leptospira.
Lancet 1988; 2:460-461
3. Desmyter J, van Ypersele de Strihou, van der Groen G.
Hantavirus disease. Lancet 1984; 2: 158
4. Gligic A, Obradovic M, Stqjanovic R et al Hemorrhagic fever
with renal syndrome in Yugoslavia: detection of Hantaviral
antigen and antibody in wild rodents and serological diagnosis
of human diseases. Scand J Infect Dis 1988; 20: 261-266
5. Antiniades A, Grekas D, Rossi CA, LeDuc JW. Isolation of a
Hantavirus from a severely ill patient with hemorrhagic fever
with renal syndrome in Greece. J Infect Dis 1987; 156: 1010-1013
Preferential bone mineral loss in postmenopausal
dialysed women?
Sir,
Bone mineral loss may lead to clinical manifestations, e.g.
bone pain and bone fractures [1], but the factors which
determine its genesis have not been well delineated.
We analysed bone mineral content in 52 haemodialysed
patients (30 male, 32 female). Regional bone mineral density
(BMD) was measured using dual-energy X-ray absorptiometry (DEXA; Lunar DPX Scanner) in the lumbar spine and
femoral neck respectively. BMD was expressed (i) in g/cm2,
(ii) as percentage decrease relative to the values in young
normal subjects, and (iii) as Z-score, i.e. standard deviation
from the average of age and sex-matched normal subjects.
Parathyroid status was assessed by measurements of serum
Lumbar spine BMD
relative to peak bone mass as 100%
80%
40%-|
20% -I
males
females
age < 50
age > 50
Fig. 1. Lumbar spin BMD relative to peak bone mass as 100-'.
1996 European Dialysis and Transplant Association-European Renal Association