Prospective Study of Tetanus-Induced Acute Renal Dysfunction: Role of Adrenergic Overactivity

Elizabeth F. Daher Division of Nephrology, Department of Medicine, University of Sao Paulo Medical School, Intensive Care Unit, Division of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

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Regina C. R. M. Abdulkader Division of Nephrology, Department of Medicine, University of Sao Paulo Medical School, Intensive Care Unit, Division of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

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Eduardo Motti Division of Nephrology, Department of Medicine, University of Sao Paulo Medical School, Intensive Care Unit, Division of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

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Marcello Marcondes Division of Nephrology, Department of Medicine, University of Sao Paulo Medical School, Intensive Care Unit, Division of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

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Emil Sabbaga Division of Nephrology, Department of Medicine, University of Sao Paulo Medical School, Intensive Care Unit, Division of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

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Emmanuel A. Burdmann Division of Nephrology, Department of Medicine, University of Sao Paulo Medical School, Intensive Care Unit, Division of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil

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DOI:
https://doi.org/10.4269/ajtmh.1997.57.610
Volume/Issue:
Volume 57: Issue 5
Page(s):
610–614
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To assess the mechanisms related to tetanus-induced acute renal failure (ARF), 30 patients with tetanus had their renal function prospectively studied and factors possibly related to renal changes were evaluated during four weeks of hospitalization. Fifty percent of these patients had a glomerular filtration rate (GFR) ≤ 50 ml/min in the first or second week of hospitalization (Group I) and 50% had a GFR > 50 ml/min throughout the entire hospitalization period (Group II). Age, gender, tetanus incubation time and tetanus onset time, hospitalization time, use of nephrotoxic drugs, need for mechanical ventilation with intermittent positive pressure, and presence of systemic infection were similar in both groups. None of the patients presented with oliguria. Autonomic nervous system (ANS) overactivity, characterized by intense variations in systolic and diastolic blood pressure, by increased heart rate and elevated urinary metanephrine excretion, was higher in Group I compared with Group II. Plasma renin activity, serum creatinephosphokinase levels, and myoglobinuria were not significantly different between the two groups. These results strongly suggest that tetanus-induced ARF has a high prevalence, is characterized by early onset, and is probably related to ANS overactivity.

Author Notes

Copyright:
Copyright © 1997 by The American Society of Tropical Medicine and Hygiene 1997
Published Online:
Nov 1997
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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