Reversal of renal tubule transporter down-regulation during severe leptospirosis with antimicrobial therapy

Spichler, Anne

doi:10.1590/s0036-46652007000600013

Cited by 6 publications

(12 citation statements)

References 40 publications

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“…These findings suggest that inflammation is most probably a secondary feature following acute epithelial damage and is observed in patients who survive long enough to develop it. This association between tubular and inflammatory lesions and early/late infection can be easily demonstrated in the hamster model [18]. ATN was recently reported as a usual feature in human necropsies being detected in 13/15 patients from Moldova [15].…”

Section: Pathologymentioning

confidence: 63%

“…This was based on the observation of a sodium wasting defect paralleling preserved ascending limb function [14]. More recently, two experimental studies in hamster models reported down regulation of the proximal tubule type III Na + / H + exchanger during acute infection [18,23].…”

Section: Proposed Specific Transport Defects In Tubular Epithelial Cellsmentioning

confidence: 99%

“…It remains to be clarified whether such findings are reproducible in larger series and whether this is a typical manifestation of serovar Shermani or is shared by all pathogenic leptospires. In an experimental assay to study the role of antibiotics on reversal of tubular transporter defects, the infection by serovar Copenhageni induced both loss of expression of NHE3 in the proximal tubule as well as loss of NKCC2 in TAL which could be prevented by the use of ampicillin in the late stage of infection [18].…”

Section: Proposed Specific Transport Defects In Tubular Epithelial Cellsmentioning

confidence: 99%

“…We recently described evidence that, even in late disease, ampicillin may reverse loss of expression of renal transporters (NHE3 and NKCC2) in the hamster model [18].…”

Section: Treatment -The Role Of Antibioticsmentioning

confidence: 99%

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Renal involvement in leptospirosis: new insights into pathophysiology and treatment

Cerqueira¹,

Athanazio²,

Spichler³

et al. 2008

Braz J Infect Dis

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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.

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Section: Pathologymentioning

confidence: 63%

Section: Proposed Specific Transport Defects In Tubular Epithelial Cellsmentioning

confidence: 99%

Section: Proposed Specific Transport Defects In Tubular Epithelial Cellsmentioning

confidence: 99%

“…We recently described evidence that, even in late disease, ampicillin may reverse loss of expression of renal transporters (NHE3 and NKCC2) in the hamster model [18].…”

Section: Treatment -The Role Of Antibioticsmentioning

confidence: 99%

See 2 more Smart Citations

Renal involvement in leptospirosis: new insights into pathophysiology and treatment

Cerqueira¹,

Athanazio²,

Spichler³

et al. 2008

Braz J Infect Dis

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“…Antibiotic therapy was associated with a significant reduction in leptospira antigens, normal expression of NHE3 and NKCC2 transporters, and reduced levels of TBARS. 42 However, clinical studies have shown that antibiotic therapy is efficient in the early and late phases of the disease. 49 Based on the recommendation of the World Health Organization of 2003, severe leptospirosis should be treated with intravenous penicillin (1,500,000 U every 6h), ceftriaxone (1g once a day), or cefotaxime (1g every 6h), all equally effective.…”

Section: Treatment Antibiotic Therapymentioning

confidence: 99%

Insuficiência renal aguda associada à leptospirose

Daher¹,

Abreu

Silva³

2010

J. Bras. Nefrol.

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Leptospirosis is the most important zoonosis in the world. Patients are typically young men. Several factors are involved in acute kidney injury (AKI) in leptospirosis, including direct nephrotoxic action of the leptospira, hyperbilirubinemia, rhabdomyolysis and hypovolemia. The major histological findings are acute interstitial nephritis and acute tubular necrosis. Leptospirosis-induced AKI is usually nonoliguric and hypokalemic. Tubular function abnormalities precede a decline in the glomerular filtration rate, which could explain the high frequency of hypokalemia. Antibiotic treatment is efficient in the early and late and/or severe phases. For critically ill leptospirosis patients, the following measures are recommended: early and daily hemodialysis; low volume infusion (due to the risk of pulmonary hemorrhage); and lung-protective strategies. Mortality in leptospirosis-associated AKI is around 22%.

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The kidney in leptospirosis

Abdulkader

Silva

2008

Pediatr Nephrol

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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 approximately 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.

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Reversal of renal tubule transporter down-regulation during severe leptospirosis with antimicrobial therapy

Abstract: SUMMARY OF THESIS*SPICHLER, Anne Stambovsky -Leptospirose letal aguda em hamster: caracterização de perfis bioquímicos, histopatológicos e celulares renais, relacionada a ensaios terapêuticos. São Paulo, 2007.

Cited by 6 publications

References 40 publications

Renal involvement in leptospirosis: new insights into pathophysiology and treatment

Renal involvement in leptospirosis: new insights into pathophysiology and treatment

Insuficiência renal aguda associada à leptospirose

The kidney in leptospirosis

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