Acute renal failure in non-fulminant hepatitis A.

A previously healthy 30-year-old man was admitted to our hospital on 24 February 1995, because of generalized jaundice skin discoloration and decreasing urine output for 2 days. He had malaise and fever 7 days before admission, which was treated as an upper respiratory infection at a local clinic. There was no history of hepatic and renal disease. At the time of admission, his blood pressure was 130/90 mmHg, pulse rate 90 per min, and body temperature 36.6°C. Physical examination showed icteric skin but no signs of fluid depletion or hepatomegaly. Initial blood biochemistry revealed BUN 74mg/dl, creatinine 10.4mg/dl, albumin 3.4 mg/dl, calcium 6.9 mg/dl, phosphorus 5.9 mg/dl, and uric acid 13.5 mg/dl. The serum alanine transferase (SGPT) was 2348 Units, aspartate aminotransferase (SGOT) 3461 Units and total bilirubin 9.8 mg/dl. The haemoglobin was 15.4 g/dl, white blood cell count 9800/mm with a normal differential count and coagulation test within normal limits. Hepatitis B surface antigen and hepatitis C antibody were negative, but IgM antibody to hepatitis A virus (HAV) was positive by radioimmunoassay. Serum level of C3 was 157 mg/dl, C4 36 mg/dl. Urinalysis showed a trace