Korean hemorrhagic fever is a disease with an acute onset of severe hemorrhagic tendency and acute renal failure. Acute renal failure may be produced by inducing intravascular coagulation in experimental animals, and also, coagulation mechanisms may play a pathogenetic role in certain human renal diseases. One of the clinical consequences of DIC is serious ischemic tissue damage due to capillary flow blocking by fibrin deposits. The kidney is particularly vulnerable to ischemic effects. For the detection of intravascular coagulation, FDP assay is known as a more sensitive and reliable test than are other coagulation studies. Therefore, from September, 1973 to January, l974, the serum and the urine of the selected patients with Korean hemorrhagic fever who had a typical clinical course were subjected to study. The alterations of the serum and urinary FDP concentrations, and the other hematologic, blood chemistry, and urinary examinations were studied in a total of 177 examples of each febrile, hypotensive, oliguric, diuretic, and convalescent phase. Both the serum and urinary FDP concentrations were significantly higher than normal. This data indicates that DIC is detected in Korean hemorrhagic fever, where it may play a major pathogenetic role. And the urinary FDP concentration more closely reflects the severity of renal lesions in this disease than does the serum FDP concentration and the blood urea nitrogen level. It can be assumed that the concentration of urinary FDP can be used as a therapeutic criteria, and is correlated to the intensity and the prognosis of the disease. Also the possibility of improvement following anticoagulant treatment may be proposed. It appears that acute renal failure in this disease has a close relationship to DIC. In its pathogenesis it can be assumed that disruption of the renal cortical perfusion plays a major role in this Korean hemorrhagic fever.
Blood Urea Nitrogen ; Disseminated Intravascular Coagulation/etiology* ; Disseminated Intravascular Coagulation/metabolism ; Female ; Fibrin Fibrinogen Degradation Products/metabolism* ; Hemorrhagic Fevers, Viral/blood* ; Hemorrhagic Fevers, Viral/urine ; Human ; Kidney Failure, Acute/etiology* ; Korea ; Male

Hypoalbuminemia frequently occurs in Hemorrhagic Fever with Renal Syndrome (HFRS), but clinical significance of hypoalbuminemia is not well known. This study was designed to evaluate hypoalbuminemia as a marker of severity of disease in patients with HFRS. We evaluated the relationship between the level of serum albumin and clinical parameters representing the severity of disease in 144 patients with HFRS. The patients were divided into three groups based on the level of serum albumin; Group I (normal serum albumin), Group II (serum albumin <3.5 g/dL and > or =3.0 g/dL), and Group III (serum albumin <3.0 g/dL). Of the total of 144 patients, 42 patients (29.2%) were categorized as Group I, 39 patients (27.1%) as Group II, and 63 patients (43.8%) as Group III. Group III had a higher rate of incidence in episode of hypotension, pulmonary edema than did Group I and Group II. The lowest level of serum albumin was positively correlated with platelet count (r=0.505, p<0.001) and was negatively correlated with leukocyte count (r=-0.329, p<0.001), BUN (r=-0.484, p<0.001), serum creatinine (r=-0.394, p<0.001), and AST (r=-0.251, p=0.002). Our data suggest that hypoalbuminemia frequently occurs in the acute stage of HFRS, and level of serum albumin is associated with the disease severity of HFRS.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Fluorescent Antibody Technique, Indirect ; Hemorrhagic Fevers, Viral/*blood/mortality ; Human ; Hypoalbuminemia/blood ; Kidney Diseases/*blood/mortality ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin/*biosynthesis ; Treatment Outcome

BACKGROUNDTo further probe into the role of CD178 in the pathogenesis of hemorrhagic fever with renal syndrome (HFRS).

METHODSThe expression of CD178 and HLA-DR on T cell subsets in peripheral blood of patients with HFRS and their dynamic changes were detected by Flow cytometry.

RESULTSCD4+ CD178+ and CD8+ CD178+ T lymphocytes both in fever and polyuria phases were significantly higher than those in normal controls, while there was no significant difference between the both phases of HFRS (P > 0.05). CD178 expression on CD4+ HLA-DR+ and CD8+ HLA-DR+ T lymphocytes were significantly higher than those in normal controls (P < 0.05, P < 0.01, P < 0.001, P < 0.001), while there was no significant difference between CD4+ HLA-DR+ and CD8+ HLA-DR+ T lymphocytes (P > 0.05).

CONCLUSIONCD178 was expressed on both CD4+ and CD8+ T cell subsets, but mainly on CD8+ T cell subsets both in early stage and in later stage in the pathogenesis of HFRS. Cytotoxic T lymphocyte (CTL) might kill target cells infected by hantavirus (HV) and eliminate HV via cell apoptosis mediated by CD178 in early stage of HFRS. In later stage of HFRS, CD178 might reduce antigen-specific T lymphocytes by activation induced cell death (AICD) and help to maintain the homeostasis of immune system.

Adolescent ; Adult ; CD4-Positive T-Lymphocytes ; cytology ; immunology ; CD8-Positive T-Lymphocytes ; cytology ; immunology ; Fas Ligand Protein ; immunology ; Female ; Flow Cytometry ; Hemorrhagic Fever with Renal Syndrome ; blood ; immunology ; Hemorrhagic Fevers, Viral ; blood ; immunology ; Humans ; Male ; Middle Aged ; T-Lymphocyte Subsets ; cytology ; immunology ; Young Adult