Influence of ibuprofen, diclofenac or paracetamol on kidney function in patients with hantavirus infection
InstitutionsUKU. Klinik für Innere Medizin I
UKU. Institut für Virologie
Hantavirus (Puumala type) is endemically and epidemically transmitted by the small mouse called bank vole Chionomys glareolus as host animal in southern parts of Germany. Painful symptoms like headache, myalgia, lumbago as well as thrombocytopenia with macrohaematuria and conjunctival bleeding are symptoms of Hantavirus infection. Although nephropathia epidemica is a self-limited disease acute kidney injury may occur associated with oedematous tubulo-interstitial nephritis. Our hypothesis was that the extent of kidney injury correlates with the amount of taken nephrotoxic non-steroidal anti-inflammatory drugs. Over the time of 8 years, namely 2004 to 2012, we retrospectively and exploratively evaluated the clinical course of hantavirus infections in 115 patients. All were inhabitants of the geographic area "Schwäbische Alb". Laboratory findings and patient records were analyzed. Criterion for an acute Hantavirus infection was detection of specific IgM antibodies. The amount of NSAIDs intake was quantitated by the defined daily dose (0 – 1 – 2 – 3 and more). Of the115 patients 38 were women and 77 were males. The mean value for age was 39 years (SD 14), body mass index 31 kg/m2 (SD 13), platelet count 117 /nl (SD 40), lactate dehydrogenase 273 U/l (SD 65), maximum serum creatinine 346 mcmol/l (SD 242) and the mean DDD was 1.34 pills per day of NSAIDs (SD 1.4). In the multivariate linear regression analysis the DDDs of analgesics was significantly associated with the maximum serum creatinine (odds ratio OR = 44; CI-95% = 21:67; p < 0.0005). Contrasting to our expectations, neither age, gender, body mass, thrombocytopenia or lactate dehydrogenase was identified as significant risk factors for the maximum serum creatinine level. In case of suspected hanta virus infection and pain it is very important not to treat symptoms using NSAIDs but other non nephrotoxic analgesics like metamizol. It is our goal to call attention to this preventable thread and to inform family physicians in the areas above.
Subject HeadingsHanta-Virus [GND]
Hantavirus infections [MeSH]
Anti-inflammatory agents, Non-steroidal [MeSH]
Drug-related side effects and adverse reactions [MeSH]