TMSS Medical College Journal

A 35 years male patient presented with fever and diagnosed as a case of dengue haemorrhagic fever (DHF). He subsequently developed nephrotic range of proteinuria. The patient did not have classical nephrotic syndrome. The proteinuria improved without specific treatment. A renal biopsy was not performed due to self-resolution of the proteinuria and as azotemia was absent. Heavy proteinuria is not a typical characteristic of dengue virus infection. Dengue fever with nephrotic range proteinuria is a rare presentation reported so far.

Dengue virus infection is one of the most prevalent viral induced hemorrhagic disorders of public health significance, with millions of infections each year. The main dengue vector is the female of the Aedes aegypti mosquito. There are four serotypes of the dengue virus (DEN-1-DEN-4), a RNA flavivirus. Various clinical manifestations have been described during the viremic stage. Bleeding diathesis and vascular leakage are major complications. Renal problems may develop, including acute kidney injury (AKI) from dengue, shock syndrome (DSS) and IgA nephropathy, which are transient. Massive proteinuria is not a common finding in patients with dengue hemorrhagic fever (DHF). We report a case of The patient did not have any haematuria, casts in his urine but have 3+ proteinuria and 24 hour urinary total protein was 0.68 gm. His serum creatinine level was normal throughout the admission. As nephrotic-level proteinuria is not usually associated with DHF, screening for other causes of proteinuria were done. Complement levels (C3, C4) was within normal limit. Post-infectious causes such as hepatitis B, hepatitis C and streptococcusan- tistreptolysin O titre (ASOT) were negative. A repeat 24-hour urine total protein normalised to 0.06 g/day. We concluded this self-limiting nephrotic-range proteinuria is most likely due to the dengue viral infection.