A patient with tetanus may develop acute renal failure, which can significantly impact the prognosis. A number of factors may affect the risk for developing renal failure.


The main cause of renal dysfunction is the adrenergic/autonomic/sympathetic overactivity/instability seen in severe tetanus.


Additional risk factors that may contribute to development of the renal failure::

(1) sepsis with hypotension or shock

(2) therapy with nephrotoxic drugs (such as aminoglycosides)

(3) rhabdomyolysis (especially during tetanic muscle spasms)

(4) hypovolemia

(5) cardiac arrest


Features of autonomic overactivity that may affect renal function:

(1) alternating tachycardia and bradycardia

(2) wide variation in blood pressure from alternating hypotension and hypertension

(3) hyperthermia

(4) cardiac arrhythmias


The autonomic overactivity can be monitored by the elevation in urinary metanephrine excretion.


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