Clinical profile of patients with leptospirosis requiring hemodialysis and intensive care (original) (raw)
Related papers
2014
Leptospirosis is most widespread zoonotic infection prevalent in hot and humid regions of the world. Severe form of disease is accompanied by several fatal complications. Kidney involvement is most dreaded complication of leptospirosis varies from urine sedimentations to severe acute kidney injury (AKI). Leptospiral AKI (LAKI) is most common and fatal intricacy of leptospirosis with incidence varying from 40-60% and a mortality rate of about 22%. LAKI leads to higher mortality rate and longer hospital stay as compared to those without acute kidney injury. Currently there is no such systemic review that describes association of acute kidney injury with leptospirosis and its impact on mortality and hospital stay. We systematically reviewed 35 research publications showing association of leptospirosis with acute kidney injury. Predictors of leptospiral acute kidney injury and mortality associated with leptospiral AKI were also observed. Most of the participants were male, rural residents and belong to leptospirosis risk groups. Mean hospital stay was 4-15 days and longer hospitalization was found in patients with severe form of acute kidney injury, multi organ failure and wrong diagnosis. Similarly mortality rate was around 19% which is also validated with previous findings. High mortality rate was found in severe acute kidney injury with multi organ failure. Other findings with LAKI were hypokalemia, oliguria and thrombocytopenia.
Incidence and Characteristics of Acute Kidney Injury in Leptospirosis; a Retrospective 5 Year Study
ackground: Leptospirosis is most widespread zoonotic disease endemic in warm and humid climate.The incidence of leptospirosis in Malaysia is 13%. Renal involvement is most dreaded complication of leptospirosis and is most common cause of death. Incidence of leptospirosis induced acute kidney injury (AKI) is 40-60% having mortality rate of around 22%. Methods: A 5 years (2004-2008) retrospective database for patients presenting with leptospirosis was initiated at tertiary care hospital, Kelantan, Malaysia. Patients with concurrent infections, incomplete demographics and renal function tests were excluded from study. Results: A total of 45 (Male: 40, Female: 5, ratio 8:1) leptospirosis patients with mean age of 38.6 ± 14.31 years were enrolled in this study. According to AKIN classification, overall incidence of AKI was 46.6%. Incidence was higher (61.1 %) in risk groups as compared to non-risk groups (38.9%). AKIN-1 was seen in 6 (16.7%) patients while 7 (19.4%) and 8 (22.2%) patient...
Acute Renal Failure in Leptospirosis
Renal Failure, 1997
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.
2017
Background: Leptospirosis has a wide range of clinical presentation from mild to severe disease with organ dysfunctions and death. There are risk and prognostic factors for severity and mortality including demographic, epidemiological, clinical presentations and laboratory results. Early recognition of risk factors enables early ICU care and organ supports. Purpose: The study was conducted to identify the risk and prognostic factors for severe leptospirosis and its mortality. Methods: This was a retrospective case-control study carried out in the general ICU in Hospital Raja Perempuan Zainab II from 1st January 2013 to 31st December 2016. Patients who presented with severe organ involvement which required dialysis, tracheal intubation and mechanical ventilation, vasopressors or inotropes, transfusion or death were grouped as cases. Controls were defined as patient with mild organ involvement without requirement or with minimal organ supports. Chi-Square test, Fisher‘s exact test, St...
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.
Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka
BMC Research Notes, 2014
Background: Leptospirosis is an important zoonotic disease of variable severity and is a common cause of acute kidney injury (AKI) in tropics. However the knowledge on long term renal outcome in leptospirosis is scarce. This study aims to assess the long-term renal outcome of AKI caused by leptospirosis. Findings: Hospital records of patients who had developed AKI following leptospirosis (Serologically confirmed) presented to two Teaching Hospitals in Kandy district over 3 years from 2007 were studied. A total of 44 patients were included and they had been followed up at least for one year in out patient clinics with regular assessment including renal status. Renal histology was studied in two patients. The primary outcome measure was normalization of renal function at one year. Of the 44 patients, 31 were in the risk and injury stage (Group 1), and the rest of them were in the failure stage (Group 2) under RIFLE criteria. Of group 2 patients, 11 had abnormal renal functions on discharge. Their mean serum creatinine and GFR values on discharge were 392 mmol/l and 20 ml/min/1.73 m 2 . Other two patients had full renal recovery whilst in the hospital. Nine in the group 2 required renal replacement therapy by means of peritoneal dialysis, intermittent haemodialysis or haemofiltration. Seventeen out of the total had persistently abnormal renal functions on discharge. Of them 13 recovered their renal functions to normal. Four patients (9%) who belonged to group 2, had persistently abnormal renal functions after first year compatible with stage 3 chronic kidney disease (CKD). Renal histology of two patients showed tubulointerstitial lymphocyte infiltrate, tubular atrophy and interstitial fibrosis.
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.
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).
Acute kidney injury in leptospirosis: Overview and perspectives
Asian Pacific Journal of Tropical Medicine, 2018
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.