State of microcirculation in patients with hemorrhagic fever with renal syndrome

Topicality. Hemorrhagic fever with renal syndrome is a significant natural focal infection in Russia. A key pathogenetic mechanism is endothelial dysfunction, leading to impaired microcirculation. However, its detailed assessment in patients with varying degrees of disease severity remains an urgent task. The aim of the study was to determine the state of microcirculation depending on the severity and stage of hemorrhagic fever with renal syndrome.
Object and methods. An open prospective study included 85 patients. The comparison group consisted of 30 conditionally healthy individuals. Microcirculation parameters were assessed using laser Doppler flowmetry: basal perfusion level, nutritive and shunt blood flow, and coefficient of variation. The examination was conducted during the oliguric and polyuric periods of the disease. Outcomes. In patients with moderate and severe forms of the disease, a type of microcirculation impairment not corresponding to classical patterns was recorded in both periods. While maintaining a normal average perfusion level, a statistically significant increase in nutritive blood flow, a decrease in shunt blood flow, and an increase in the coefficient of variation were detected in the forearms and lower legs compared to the control group. No significant differences in microcirculation parameters were found between the disease periods or between the groups with different severity.
Findings. Hemorrhagic fever with renal syndrome is characterized by a specific impairment of microcirculation, manifested by redistribution of blood flow in favor of the nutritive bed and increased tension in regulatory mechanisms. These changes are persistent, remaining in the polyuric period and independent of the initial disease severity, which underscores the prolonged nature of endothelial dysfunction.

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