key: cord-0006449-kic22xy6
authors: Wiwanitkit, Viroj
title: Renal insufficiency on presentation of bird flu infection: is it correlated to outcome?
date: 2006
journal: Clin Exp Nephrol
DOI: 10.1007/s10157-005-0381-8
sha: 60ec4e10c49033ac609420aa76e4c39a680d4b37
doc_id: 6449
cord_uid: kic22xy6

nan

Bird flu or avian flu, caused by the H5N1 virus, is a new emerging infectious disease. There has been a worldwide situation regarding avian influenza infections in poultry since 1997. Recently, H5N1 caused severe disease with high mortality in humans in Vietnam and Thailand. 1 Most infected patients usually developed progressive pneumonia with acute respiratory distress syndrome and consequently died. It is postulated that, in fatal human infections with this avian subtype, the initial virus replication in the respiratory tract triggers hypercytokinemia complicated by other organ involvement. 2 Renal involvement of bird flu infection has been reported. To et al. 2 recently reported the autopsy findings of acute renal failure (ARF) in fatal human bird flu infection. However, the pathogenesis underling the renal involvement in still not clarified. Wiwanitkit 3 recently noted that hypercreatinemia could be an important manifestation of human bird flu infection.

Here, the author reports a ministudy carried out in order to assess the correlation between the presence of renal insufficiency and the outcome among reported Thai patients. The operative definition of renal insufficiency in this study is serum creatinine equal to or more than 1.5 mg/dl. The author performed a literature review of reports of human bird flu infection in Thailand, from a database of published works cited in the Index Medicus and the Science Citation Index. The author also reviewed the published works in all 256 local Thai journals, which are not included in the international citation index, for reports of human bird flu infection in Thailand. Reports that contained in complete data were excluded from the analysis.

According to this review, there were six reports 4-9 covering 12 Thai patients with a confirmed diagnosis of bird flu. However, complete data were available for only 9 patients. Of these 9, renal insufficiency was detected on presentation in 4 patients (44.4%). In all 4 of these patients with renal insufficiency, acute respiratory distress syndrome (ARDS) was detected, and all died. Concerning the other 5 patients without renal insufficiency, ARDS was detected in 4, and there were 2 fatalities. Although the fatality rate in the patients with renal insufficiency was higher than that in those without, there was no significant correlation between the presence of renal insufficiency and the development of ARDS (P > 0.05) or fatality (P > 0.05).

There are some reports on the clinical presentation and outcome of severe bird flu infection. Wiwanitkit 10 recently proposed that diarrhea could be noted as an important presentation of bird flu and could imply a severe outcome. Here, the author has tried to assess whether there was a correlation of renal insufficiency with the infection outcome. The author hereby concludes that the presence of renal insufficiency showed no clinical correlation with the outcome of infection among the subjects reviewed.

Avian influenza virus

Pathology of fatal human infection associated with avian influenza A H5N1 virus

Level of blood creatinine in the recent reported cases of bird flu infection in Thailand and Vietnam

Avian influenza virus infection of children in Vietnam and Thailand

Cases of Influenza A (H5N1) -Thailand

Preliminary clinical description of influenza A (H5N1) in Thailand

A child with avian influenza A (H5N1) infection

Cases of influenza A (H5N1) -Thailand

Available at http//www.flu.org.cn 10. Wiwanitkit V. Diarrhea as a presentation of bird flu infection: a summary on its correlation to outcome in Thai cases