Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis?

Abstract

Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120µg/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.

Lp25 membrane protein from pathogenic Leptospira spp. is associated with rhabdomyolysis and oliguric acute kidney injury in a guinea pig model of leptospirosis

“…The decrease in GFR may not be directly dependent on the tubular damage because the FE Na was not different between the three groups. Previous clinical studies also demonstrated that rhabdomyolysis-induced acute renal injuries did not modify sodium excretion [36–38]. …”

Pancreatic involvement in fatal human leptospirosis: clinical and histopathological features

“…Hypokalemia and polyuria in patients with leptospirosis suggest an increase in distal potassium secretion secondary to increased distal sodium delivery 32 . Ionic hypocalcemia was also observed and could be due to rhabdomyolysis or acute pancreatitis 1,24,27,36 .…”

Leptospirosis

“…Rare complications include cerebrovascular accidents (224,346), rhabdomyolysis (133,374,537), thrombotic thrombocytopenic purpura (336), acute acalculous cholecystitis (44, 401, 600), erythema nodosum (157), aortic stenosis (91), Kawasaki syndrome (291,636), reactive arthritis (633), epididymitis (285), nerve palsy (516,578), male hypogonadism (437), and Guillain-Barré syndrome (403). Cerebral arteritis, resembling Moyamoya disease, has been reported in a series of patients from China (650).…”