[Skip to Content]
[Skip to Content Landing]
September 1960

Renal Residuals of Acute Epidemic Hemorrhagic Fever

Author Affiliations
From the Department of Metabolism, Division of Medicine, Walter Reed Army Institute of Research, Walter Reed Army Medical Center (Major Rubini, Lt. Col. McDowell), and the Follow-Up Agency, National Research Council, Washington, D.C. (Dr. Jablon).
Arch Intern Med. 1960;106(3):378-387. doi:10.1001/archinte.1960.03820030066011

Renal damage of varying degree was invariably associated with acute epidemic hemorrhagic fever (EHF) in the Korean experience.1,9,19,21 Profuse albuminuria was an important criterion of the diagnosis early in the course of the illness, and subsequently hematuria, cylindruria, and hyposthenuria were regularly found. In the more severe cases, oliguria, and on occasion, brief anuria supervened,1,2,17,19 usually, but not invariably associated with protracted hypotension.2,5 Yet, knowledge of the natural course of the renal lesion is restricted to relatively acute experience of the initial illness,5,12,16,19 and there is insufficient reported data on which to base any long-range prognosis. As some 2,000 individuals recovered from diagnosed EHF, it would seem important to consider the likelihood of chronic renal impairment after apparent recovery from acute EHF.

Pathologic studies of patients dying during the acute illness stressed the extensiveness and severity of the renal lesions. The acute changes in the kidney included marked parenchymatous degeneration

These studies were initiated, encouraged, and supported by the Followup Committee on Epidemic Hemorrhagic Fever appointed by the Office of the Surgeon General, Department of Army.
The data was drawn from the clinical records and is, inevitably, incomplete in some respects. It was fortunate, however, that because of the great interest that existed in EHF as a disease and the many studies that were undertaken, the clinical records were somewhat more detailed than might ordinarily be the case, especially for those men who were not very sick during the acute episodes. For about 60% of the men the clinical records included the judgment of the physician responsible for the case as to the classification as mild, moderate, or severe EHF. The practice of classification was not generally followed in 1951, but in 1952 and 1953 most cases were classified. It was evident from an examination of the trend of classification in time, that the physicians' criteria for a "severe" case grew more stringent as their experience increased. There was also, undoubtedly, a certain measure of personal judgment in individual physician's categorizations. Nevertheless, the classification was strongly correlated with the individual clinical observations and it has been employed as a useful, if not perfect, device for dividing the cases into severity groups. Here, for the sake of brevity, the moderate and severe cases are singled out as a group for contrast with the whole body of material.
Barbero, G. J.; Katz, S.; Kraus, H., and Leedham, C. L.:  Clinical and Laboratory Study of 31 Patients with Hemorrhagic Fever ,  A.M.A. Arch. Int. Med. 91:177, 1953.Crossref
Earle, D. P.:  Symposium on Epidemic Hemorrhagic Fever: Analyses of Sequential Physiologic Derangements in Epidemic Hemorrhagic Fever with Commentary on Management ,  Am. J. Med. 16:690, 1954.Crossref
Entwhisle, G., and Hale, E.:  Hemodynamic Alterations in Hemorrhagic Fever ,  Circulation 15: 414, 1957.Crossref
Finkenstaedt, J. T., and Merrill, J. P.:  Renal Function After Recovery from Acute Renal Failure ,  New England J. Med. 254:1023, 1956.Crossref
Froeb, H. F., and McDowell, M. E.:  Symposium on Epidemic Hemorrhagic Fever: Renal Function in Epidemic Hemorrhagic Fever ,  Am. J. Med. 16:671, 1954.Crossref
Hullinghorst, R. L., and Steer, A.:  Symposium on Epidemic Hemorrhagic Fever: Pathology of Epidemic Hemorrhagic Fever ,  Ann. Int. Med. 38:77, 1953.Crossref
Kessler, W. H.:  Symposium on Epidemic Hemorrhagic Fever: Gross Anatomic Features Found in 27 Autopsies of Epidemic Hemorrhagic Fever ,  Ann. Int. Med. 38:73, 1953.Crossref
Knowlton, M.; Horner, W. H.; Seligson, D., and Iber, F. L.:  Analytical Procedures , Washington, D.C., U.S. Army Medical Service Graduate School, Walter Reed Army Medical Center, August, 1955.
Leedham, C. L.:  Symposium on Epidemic Hemorrhagic Fever: Epidemic Hemorrhagic Fever; a Summarization ,  Ann. Int. Med. 38:106, 1953.Crossref
Lowe, K. G.:  The Late Prognosis in Acute Tubular Necrosis: An Interim Follow-Up Report on 14 Patients ,  Lancet 1:1086, 1952.Crossref
Lukes, R. J.:  Symposium on Epidemic Hemorrhagic Fever: Pathology of 39 Fatal Cases of Epidemic Hemorrhagic Fever ,  Am. J. Med. 16: 639, 1954.Crossref
Mayer, C. F.:  Epidemic Hemorrhagic Fever of the Far East (EHF) or Endemic Hemorrhagic Nephroso-Nephritis ,  Lab. Invest. 1:291, 1952.
Meroney, W. H.; Rubini, M. E., and Blythe, W. B.:  The Effect of Antecedent Diet on Urine Concentrating Ability ,  Ann. Int. Med. 48:568, 1958.
Oliver, J.:  Correlations of Structure and Function and Mechanisms of Recovery in Acute Tubular Necrosis ,  Am. J. Med. 15:535, 1953.Crossref
Oliver, J., and MacDowell, M.:  The Renal Lesion in Epidemic Hemorrhagic Fever ,  J. Clin. Invest. 36(Pt. 2):99, 1957.Crossref
Powell, G. M.:  Epidemic Hemorrhagic Fever: Study of 300 Cases ,  Medicine 33:97, 1954.Crossref
Sheedy, J. A.; Froeb, H. F.; Batson, H. A.; Conley, C. C.; Murphy, J. P.; Hunter, R. B.; Cugell, D. W.; Giles, R. B.; Bershadsky, S. C.; Vester, J. W., and Yoe, R. H.:  Symposium on Epidemic Hemorrhagic Fever: The Clinical Course of Epidemic Hemorrhagic Fever ,  Am. J. Med. 16:619, 1954.Crossref
Steer, A.:  Pathology of Hemorrhagic Fever: A Comparison of the Findings, 1951 and 1952 ,  Am. J. Path. 31:201, 1955.
Swift, W. E., Jr.:  Symposium on Epidemic Hemorrhagic Fever: Clinical Aspects of the Renal Phase of Epidemic Hemorrhagic Fever ,  Ann. Int. Med. 38:102, 1953.Crossref
Syner, J. C., and Markels, R. A.:  Continuous Renal Clearance Studies in Epidemic Hemorrhagic Fever ,  U.S. Armed Forces M.J. 6:807, 1955.
U.S. Army Technical Bulletin, TB MED 240, 1953.