Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome

Abstract

<jats:p>Leptospirosis is considered a zoonosis acquired predominantly from contaminated surfaces and water, more commonly in emerging countries with limited sanitary conditions. Leptospira in the host unleashes an immune response that explains the symptoms and clinical signs; once it reaches the kidney and liver tissue, it can manifest with alterations that lead to acute and chronic diseases in both organs. Weil’s syndrome is the best known clinical manifestation with jaundice and acute kidney injury that could lead to multiple organ failure and death. For its diagnosis, there are simplified scores such as the SPiRO score, the microbiological criteria by microscopy or serological tests; the treatment focuses on antibiotics and, if necessary, provides organic support until the infection is curtailed. The purpose of this review was to address the impact of Lep-tospira infection on the kidney and liver, the mechanisms of organ damage, the clinical presentation, and diagnosis and management of this disease.</jats:p>

Serum Potassium Trajectory during Acute Kidney Injury and Mortality Risk

“…When its levels increase, it is a feared complication [9] and is associated with poor outcomes in many different settings, including critically ill patients [10,11], and it has been one of the classic indications to start kidney replacement therapy (KRT) [12]. Hypokalemia (hypoK), on the other hand, is also observed in patients with AKI, such as in cases of acute diarrhea [13]; infections, such as leptospirosis [14]; or diuretic use [15]. In the acute setting, the risk of mortality associated with hypoK may be greater than that associated with hyperK, which is mainly related to cardiac rhythm abnormalities [16].…”

“…classic indications to start kidney replacement therapy (KRT) (12). Hypokalemia (hypoK), on the other hand, is also observed in patients with AKI, such as in cases of acute diarrhea (13); infections, such as leptospirosis (14); or diuretic use (15). In the acute setting, the risk of mortality associated with hypoK may be greater than with hyperK, which is mainly related to cardiac rhythm abnormalities (16).…”

Serum potassium trajectory during AKI and mortality risk

“…When its levels increase, it is a feared complication (9) and is associated with poor outcomes in many different settings, including critical ill patients (10,11), and it has been one of the classic indications to start kidney replacement therapy (KRT) (12). Hypokalemia (hypoK), on the other hand, is also observed in patients with AKI, such as in cases of acute diarrhea (13); infections, such as leptospirosis (14); or diuretic use (15). In the acute setting, the risk of mortality associated with hypoK may be greater than with hyperK, which is mainly related to cardiac rhythm abnormalities (16).…”