Acute Kidney Injury in Tetanus

  • Juliana Gomes Ramalho de Oliveira
  • Geraldo Bezerra da Silva JuniorEmail author
  • Guilherme Alves de Lima Henn
  • Elizabeth De Francesco Daher


Tetanus is an acute infectious disease caused by neurotoxins produced by Clostridium tetani, an anaerobic sporulated gram-positive bacillus. The infection occurs through superficial or deep wounds used as spore entry ports for contact with the continuity solution in the skin and mucosa. The action of Clostridium tetani in the body occurs through the release of exotoxins such as tetanospasmin, also known as tetanus toxin, which, due to its action of inhibiting neurotransmitter release, is responsible for the clinical manifestations of the infection, according to the class and the location of affected cells. The disease progresses in the cephalo-caudal direction, with initial involvement of the head and neck muscles, until symptoms are completely widespread. Hypertonia of the facial muscles gives the patient expressions that are characteristic of the disease, also known as tetanus face. With the evolution of the infection, the involvement of the thoracic, abdominal, and diaphragmatic muscles can lead to asphyxia, with cyanosis and respiratory failure. Acute kidney injury (AKI) in tetanus infection is common, occurs early and is associated with increased mortality, but its pathophysiology is not yet completely understood. Some factors have been studied as possible causes of AKI, such as autonomic dysfunction, rhabdomyolysis, use of nephrotoxic medications, sepsis, mechanical ventilation complications, dehydration, and changes in renal blood circulation, secondary to catecholamine surges.


Tetanus Clostridium Clostridium tetani Acute kidney injury Rhabdomyolysis 


  1. 1.
    Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington, D.C.: Public Health Foundation; 2015.Google Scholar
  2. 2.
    Brasil, Ministério da Saúde, Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. Guia de Vigilância em Saúde: Volume Único [Internet]. Brasília: Ministério da Saúde; 2017. Available from: Scholar
  3. 3.
    Focaccia R, Tavares W, Mazza CC, Veronesi R. Tétano. In: Focaccia R, editor. Tratado de Infectologia. 5th ed. São Paulo: Atheneu; 2015. p. 1373–98.Google Scholar
  4. 4.
    UNICEF. Região das Américas elimina o tétano materno e neonatal [Internet]. 2017. Available from:
  5. 5.
    European Centre for Disease Prevention and Control. Tetanus. In: ECDC Annual epidemiological report for 2015 [Internet]. Stockholm: ECDC; 2017. Available from: Scholar
  6. 6.
    Brasil. Ministério da Saúde. Tétano Acidental - Situação Epidemiológica [Internet]. Available from:
  7. 7.
    Feijão AR, Brito DMS d, Peres DA, Galvão MTG. Tétano acidental no Estado do Ceará, entre 2002 e 2005. Rev da Soc Bras Med Trop. 2007;40(4):426–30.CrossRefGoogle Scholar
  8. 8.
    Neves FF, Faiolla RCL, De Napoli EMG, De Lima GMN, Muniz RZDA, Pazin-Filho A. Clinical and epidemiological profile of accidental tetanus cases in Ribeirão Preto in the state of São Paulo from 1990 to 2009. Rev Soc Bras Med Trop. 2011;44(4):481–5.CrossRefGoogle Scholar
  9. 9.
    da Nóbrega MVD, Reis RC, Aguiar ICV, Queiroz TV, Lima ACF, Pereira EDB, et al. Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical–epidemiological profile and risk factors for mortality. Braz J Infect Dis. 2016;20(5):457–61.CrossRefGoogle Scholar
  10. 10.
    Brauner J, Vieira RS, Bleck T. Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil. Intensive Care Med. 2002;28:930–5.CrossRefGoogle Scholar
  11. 11.
    Marulappa VG, Manjunath R, Mahesh N, Maligegowda L. A ten year retrospective study on adult tetanus at the epidemic disease (ED) hospital, Mysore in Southern India: a review of 512 cases. J Clin Diagn Res. 2012;6(8):1377–80.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Lima EQ, Silva RG, Fernandes IMM, Abbud-Filho M, Burdmann EA. Case report: tetanus-induced acute kidney injury in a renal transplant recipient. Am J Trop Med Hyg. 2007;77(2):400–2.CrossRefGoogle Scholar
  13. 13.
    Lisboa T, Ho Y-L, Henriques Filho GT, Brauner JS, Valiatti JL d S, Verdeal JC, et al. Diretrizes para o manejo do tétano acidental em pacientes adultos. Rev Bras Ter Intensiva. 2011;23(4):394–409.CrossRefGoogle Scholar
  14. 14.
    World Health Organization. Current recommendations for treatment of tetanus during humanitarian emergencies [Internet]. 2010. Available from:
  15. 15.
    Gibson K, Bonaventure Uwineza J, Kiviri W, Parlow J. Tetanus in developing countries: a case series and review. Can J Anesth Can d’anesthésie. 2009;56:307–15.CrossRefGoogle Scholar
  16. 16.
    Moura Filho JF, Mendonça PR, Lima EB, Maria J, Júnior SS, Pinho MLM, et al. Acute renal failure and other clinical features in tetanus patients from northeastern Brazil. Ann Trop Med Public Health. 2008;1(2):52–5.Google Scholar
  17. 17.
    Daher EF, Silva Júnior GB. Nefropatia nas doenças tropicais. In: Riella M, editor. Princípios de Nefrologia e Distúrbios Hidroeletrolíticos. 6th ed. Rio de Janeiro: Guanabara-Koogan; 2018. p. 553–81.Google Scholar
  18. 18.
    Kaur S, Mishra D, Juneja M. Acute renal failure in tetanus. Indian J Pediatr. 2014;81(2):207.CrossRefGoogle Scholar
  19. 19.
    Cook TM, Protheroe RT, Handel JM. Tetanus: a review of the literature. Br J Anaesth. 2001;87(3):477–87.CrossRefGoogle Scholar
  20. 20.
    Martinelli R, Matos C, Rocha H, Eonir RH. Tetanus as a cause of acute renal failure: possible role of rhabdomyolysis. Rev Soc Bras Med Trop. 1993;26(l):1–4.CrossRefGoogle Scholar
  21. 21.
    Weiss MF, Badalamenti J, Fish E. Tetanus as a cause of rhabdomyolysis and acute renal failure. Clin Nephrol. 2010;73(1):64–7.CrossRefGoogle Scholar
  22. 22.
    Daher EF, Abdulkader RCRM, Motti E, Marcondes M, Sabbaga E, Burdmann EA. Prospective study of tetanus-induced acute renal dysfunction: role of adrenergic overactivity. Am J Trop Med Hyg. 1997;57(5):610–4.CrossRefGoogle Scholar
  23. 23.
    An VT, Khue PM, Yen LM, Phong ND, Strobel M. Le tétanos à Hô-Chi-Minh-Ville, Vietnam : épidémiologie, clinique et pronostic, à propos de 389 cas à l’Hôpital des maladies tropicales. Bull Soc Pathol Exot. 2015;108:342–8.CrossRefGoogle Scholar
  24. 24.
    Seedat YK, Omar M, Seedat M, Wesley A, Pather M. Renal failure in tetanus. Br Med J. 1981;282:360.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Juliana Gomes Ramalho de Oliveira
    • 1
  • Geraldo Bezerra da Silva Junior
    • 2
    Email author
  • Guilherme Alves de Lima Henn
    • 3
  • Elizabeth De Francesco Daher
    • 4
  1. 1.Post-Graduation Program in Public HealthUniversity of FortalezaFortalezaBrazil
  2. 2.Post-Graduation Programs in Public Health and Medical Sciences, School of MedicineUniversity of FortalezaFortalezaBrazil
  3. 3.Department of Community HealthFederal University of CearaFortalezaBrazil
  4. 4.Post-Graduation Program in Medical Sciences, School of MedicineFederal University of CearaFortalezaBrazil

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