ABSTRACT
During the recent 5 years we had 29 patients with hemorrhagic fever and renal syndrome complicated by a spontaneous kidney rupture. This complication occurred during an anuric period in 18 patients and within the first 24 hours of restored diuresis in 11 patients. Major clinical presentations of the kidney rupture were deterioration of lumbar and abdominal pains, meteorism and symptoms of an internal bleeding. Palpation revealed hematoma at the site of the ruptured kidney, tension of the anterior abdominal wall and symptomatic peritoneal irritation. Diagnosis of spontaneous kidney rupture in hemorrhagic fever with the renal syndrome (HFRS) relies on clinical, laboratory and ultrasound studies. Additional studies are plain urography and retroperitoneal diagnostic puncture of the affected site. Conservative therapy was given to 11 patients with erythrocyte counts of 3 x 10(12)/l or higher. The treatment was operative in 18 patients. Indications for surgery were progressive anemia, a palpable retroperitoneal hematoma and symptomatic peritoneal irritation. All patients underwent evacuation of blood clots and ligation of the renal ruptures. In the authors' opinion, renal decapsulation and pyelostomy are useful in this condition. Bilateral involvement and severe renal failure are contraindications for nephrectomy in HFRS. It may be used only as a last resort in life-threatening bleeding.
