Acute renal failure as a complication of cholera
Knobel, B.; Rudman, M.; Smetana, S.
Harefuah 129(12): 552
1995
ISSN/ISBN: 0017-7768 PMID: 8682355 Document Number: 448683
We present a 72-year-old man who had episodes of severe, acute renal failure during severe attacks of diarrhea caused by Vibrio cholerae. Patterns of acute tubular necrosis and tubulointerstitial nephritis developed following hypotension and decrease in renal blood flow, causing secondary renal ischemia. There was severe dehydration with profound hypovolemia and infection. The clinical picture included fever, weakness, arthralgia, pedal edema, mild bilateral pleural effusions, anemia, leukocytosis, azotemia with a maximum of 330 mg/dl of urea, creatinine to a maximum of 9.8 mg/dl, hypoproteinemia, severe metabolic acidosis, marked increase in lactate dehydrogenase (LDH) and creatinine phosphokinase (CPK), microscopic hematuria, sterile leukocyturia, normoglycemia glucosuria and phosphaturia and diminished tubular reabsorption of phosphorus. A short oliguria phase was followed by a polyuria phase lasting about 10 days, and glomerular and tubular function became normal after about 3 weeks. Treatment was by intensive infusions of fluids, electrolytes, sodium bicarbonate, salt-free albumin and antibiotics. To the best of our knowledge, this renal complication of cholera has not yet been described in Israel.