Hemorrhagic fever with renal disease (HFRD) is an infectious viral disease characterized by fever, capillary dilatation, and blood leakage leading to hemorrhagic manifestations and, in severe cases, associated with shock and renal impairment. It is caused by viruses of the genus Hantavirus. The disease is typically found in Asia and Europe. It usually occurs as outbreaks in an isolated event.

The incubation period lasts from 2 to 42 days, but is usually about 2 weeks. The illness is mild (with only fever, facial flush, backache, and muscle aches) or moderate (presenting the fever plus proteinuria and petechial hemorrhages) in 80% of the cases. The remaining 20% are severe.

One of the most typical early findings is a diffuse reddening of the skin, most marked over the face and V area of the neck, which may resemble severe sunburn. The degree of flush, fever, conjunctival infection and number of petechia correlate quite well with the severity of the illness. Albuminuria (presence of albumin protein in the urine), which is an almost universal finding, and the most important laboratory abnormality, appears abruptly between the second and fifth days of illness. With the onset of diuresis on about the seventh to eleventh day of illness, the diuretic phase begins. The diuresis may be extremely bulky, leading to a worsening of the fluid and electrolyte abnormalities, which may take the patient's life if not adequately treated.

Management of the ill patient includes careful monitoring of electrolytes and fluid intake and output with correction of any fluid and electrolyte imbalances, especially during the oliguric and diuretic phases. Plasma expanders should be used for shock, and hemodialysis in cases of renal failure with hyperkalemia. Ribavirin improves survival of the patient if it is given within five days of disease onset.

The prognosis of the disease depends on its severity. In milder cases, the prognosis is better.

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