Acute Renal Failure in Leptospirosis (original) (raw)
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Pediatric Nephrology, 2008
Leptospirosis is a worldwide zoonosis. Typically, patients are young men, although children can be affected. In children, this disease causes mainly alterations of sensorium. Acute renal failure and jaundice (Weil's syndrome) are less common in children than in adults. The main renal histological findings are acute interstitial nephritis and acute tubular necrosis. Acute renal failure is characterized by hypokalemia and nonoliguria. Many factors are involved in its physiopathology: hypotension, hypovolemia, rhabdomyolysis, hyperbilirubinemia, and, primarily, the direct action of leptospiral proteins. Antibiotic administration (especially early administration) reduces length of hospitalization and leptospiruria. For children, even late antibiotic treatment has been shown to reduce the extent of acute renal failure and thrombocytopenia. Although the best method of dialysis is not yet established, early and intensive dialysis can decrease mortality. Mortality in patients with acute renal failure is ∼15-20% in association with the presence of oliguria, higher levels of creatinine, and older age. Functional recovery is fast and complete; however, abnormal urinary concentration can persist.
American Journal of Case Reports, 2016
Objective: Rare disease Background: Unexplained renal insufficiency combined with hepatic failure is a common problem encountered by clinicians. As with many disease processes involving multi-organ systems, reversible causes are usually not readily identifiable, and for many patients their health deteriorates rapidly. We present a rare cause of acute renal failure and hyperbilirubinemia occurring simultaneously, with leptospirosis presenting as Weil's disease. Case Report: A 53-year-old male presented to our clinic with complaints of anuria over the past two days. His symptoms started with dark urine, severe cramps in the thighs, and chills. The patient was a visitor to the United States from Guyana. Positive physical examination findings included mild tachycardia and hypotension, scleral icterus, and tenderness over abdomen, costovertebral angles, and thighs. The patient had a high white blood cell count, thrombocytopenia, renal/hepatic insufficiency, and an urinary tract infection (UTI). The patient was initially treated under the suspicion of acute kidney injury secondary to rhabdomyolysis and pyelonephritis. The patient continued to deteriorate with decreasing platelet counts, worsening renal function, hyperbilirubinemia, and respiratory distress, with no improvement with hemodialysis. Broad-spectrum antibiotics were administered, including doxycycline, due to a high suspicion of leptospirosis. The patient's condition drastically improved after initiation of doxycycline. On subsequent days, the patient's Leptospira antibody results were available, showing titers of more than 1:3200. Hemodialysis was discontinued as the patient started producing urine with improved kidney function. Conclusions: As world travel becomes more economically feasible, we will continue to encounter foreign endemic diseases. Leptospirosis presenting as Weil's disease is a common cause of renal and hyperbilirubinemia in endemic areas. Often, as was the case for our patient where the time from presentation to acute respiratory distress syndrome (ARDS) was 72 hours, the diagnosis evolves over the course of several days. Antibody testing often takes time and delays in treatment can cause rapid clinical deterioration. In such cases, we recommend beginning empiric treatment before confirmation of laboratory tests.
Nephrology Dialysis Transplantation, 2003
Background. Renal involvement [as acute renal failure (ARF)] is a prominent feature of both mild and severe leptospirosis-a re-emerging infectious disease. Few large series describe in detail clinical and laboratory features of cases with ARF and their outcome. Methods. We performed a retrospective analysis (1997)(1998)(1999)(2000)(2001) of all consecutive, serological confirmed leptospirosis cases with ARF (ns58, 53 male, age 44" 13 years, rural residentss31%, animal contacts88%. Results. Clinical manifestations ()50% prevalence): oliguria 95%, fever and jaundice 93%, nausea and vomiting 83%, haemorrhagic diathesis 80%, headache, hepatomegaly 76%, myalgias, abdominal pain 70%, hypotension 62%, disturbed consciousness 50%. A pattern of multiple organ failure (MOF) was frequent: ARF together with hepatic failure in 72%, respiratory failure in 38%, circulatory failure in 33%, pancreatitis in 25% and rhabdomyolysis in 5% of cases. Renal dysfunction: 35% of cases had a renal K q -wasting defect and 43% a FE Na q )1% and low-osmolarity urine despite volume depletion. Haematuria was encountered in 12 and mild proteinuria in 10 subjects. Outcome: 26% deaths, 64% normal hepatic and renal function at 90 days from presentation (however 29% maintained the initial tubular defect), 10% persistent mild renal failure. All deceased patients had, beside ARF, at least two other organ failures, affected consciousness, and haemorrhagic diathesis vs a prevalence for the above features of only 34, 33, and 72%, respectively, in the survivors group (P-0.05).
Caspian Journal of Internal Medicine, 2016
Background: Renal complication of leptospirosis is common and its clinical manifestations vary from urinary sediment changes to acute renal failure. The aim of this study was to determine the final outcome of renal involvement in leptospirosis. Methods: This longitudinal prospective study included all serologically confirmed cases of leptospirosis with evidence of renal failure. All patients were followed for three months while all patients with renal failure were followed-up for one year. Results: Fifty-one patients, 53.5±14.8 years (82.4% males) with acute renal failure were studied. Over the hospitalization period, 28 patients recovered, and seven (13.72%) patients died of multiple organ failure. At the time of discharge, 16 patients had mild renal failure. Over the follow-up period, all patients recovered but in two patients renal failure persisted at creatinine level of 1.5 mg/dl. Conclusion: Development of renal failure in leptospirosis is not rare. Recovery of renal function may last several months. However, most patients recover completely at least after one year.
Renal involvement in leptospirosis: new insights into pathophysiology and treatment
Brazilian Journal of Infectious Diseases, 2008
Acute renal failure (ARF) is one of the most common complications of leptospirosis although the causal mechanisms are still unclear. Diverse mechanisms are implicated in leptospiral nephropathy and new data supports the role of peculiar ion transport defects. Besides antibiotic therapy, ARF management in leptospirosis requires dialytic therapy which is most efficient when started early. Dialysis is the standard supportive therapy even though recent evidence suggests clinical benefit from alternative treatments such as plasmapheresis and hemofiltration. Renal recovery is achieved soon after clinical improvement. The comprehension of the primary mechanisms of renal dysfunction will be helpful in the development of additional therapeutic tools for improving supportive therapy for leptospiral nephropathy. This review discusses new insights into mechanisms implicated in leptospiral ARF and recent advances in treatment.
Severe acute renal failure in a child: a rare complication of anicteric leptospirosis
Pediatric Nephrology, 2007
A 14-year-old male patient was admitted with fever, vomiting, muscular pain, mainly in the lower limbs, oliguria and oedema. The presence of rats in the vicinity of the home was reported. Laboratory tests on admission revealed severely compromised renal function and increased phosphokinase creatine and thrombocytopenia. Although the patient presented an atypical course without jaundice or meningeal involvement, early dialytic treatment was administered concomitant with empiric antibiotic therapy for leptospirosis. The probable infected serogroup by serology was Autumnalis. This atypical case illustrates that, in the presence of fever, renal failure, rhabdomyolysis and thrombocytopenia, leptospirosis should be considered, even in the absence of jaundice or meningitis, especially if there is a history of contact with carrier animals.
Risk factors for death and changing patterns in leptospirosis acute renal failure
The American journal of tropical medicine and hygiene, 1999
The risk factors for death and changes in clinical patterns in leptospirosis (Weil's disease) have not been well studied. We retrospectively studied 110 patients with Weil's disease hospitalized in Brazil between 1985 and 1996. Univariate statistical analysis showed that nonsurvivors were older than survivors, and had higher frequency of oliguria, cardiac arrhythmia, dyspnea, and pulmonary rales. Logistic regression showed that the only independent factor associated with death was oliguria (odds ratio [OR] = 8.98). The presence of arthralgia (OR = 4.71), dehydration (OR = 6.26), dyspnea (OR = 17.7), and pulmonary rales (OR = 9.91) increased after 1994. These data suggest that in Weil's disease the clinical patterns have changed and the presence of oliguria is a risk factor for death.
Clinical profile of patients with leptospirosis requiring hemodialysis and intensive care
Leptospirosis is a zoonotic condition with high morbidity. The aim of this study was to assess clinical predictive factors for intensive care admission and hemodialysis among patients with severe leptospirosis. This was an observational longitudinal study in which all patients with severe leptospirosis admitted to a tertiary hospital and receiving intensive care and hemodialysis owing to kidney injury were included in the study. 104 patients were included in the study. Mean age of the patients was 33 ± 9.8 years, of which 53% were males and the remaining 47% were females. Most common predictors for ICU care were hypotension, tachypnoea, impaired LFT and coagulation parameters and oliguria (acute kidney injury). Conclusions: Predictive factors for ICU admission in leptospirosis include oliguria, impaired coagulation profile and liver function tests, tachypnoea and hypotension.