Acute Renal Failure of Leptospirosis: Nonoliguric and Hypokalemic Forms

Abstract

Acute renal failure induced by leptospirosis was studied in 56 patients. A higher frequency of nonoliguric renal failure was observed with lower morbidity and mortality rates than in oliguric forms. In addition, 45% of the patients in this series were hypokalemic, and no hyperkalemic patients were seen. A prospective study in 11 patients showed an initially elevated urinary fractional potassium excretion that fell simultaneously with the high urinary fractional sodium excretion and the urinary K/Na ratio, suggesting an increased distal potassium secretion due to an increased distal sodium delivery consequent to functional impairment of the proximal reabsorption of sodium.

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

“…Leptospirosis is one of the few causes of AKI that may present with hypokalaemia. Seguro et al 25 found hypokalemia in 45% of 56 patients. In the present study, acute kidney injury was found in 87% of the patients and 63.7% had serum potassium lower than 3.5mEq/L.…”

Insuficiência renal aguda associada à leptospirose

“…12 Acute kidney injury due to leptospirosis usually presents in the non-oliguric form with hypokalemia, which can be detected in 41% to 45% of the patients with leptospirosis associated with AKI. 14 In a recent study, 58 patients with leptospirosis and AKI had hemorrhagic diathesis (80%), liver failure (72%), respiratory failure (38%), circulatory failure (33%), pancreatitis (25%), and rhabdomyolysis (5%). 15 Arterial hypotension is common.…”

“…56 characteristic laboratory finding of AKI of leptospirosis. Seguro et al 14 have shown that AKI of leptospirosis is usually non-oliguric and have evidenced hypokalemia in 45% of the cases. Thus, AKI of leptospirosis, regardless of its severity, hypercatabolism, rhabdomyolysis, acidosis, and oliguria, is characterized by normo-or hypokalemia.…”

“…18 Dehydration is a frequent finding, secondary to fever, vomiting, and diarrhea. 14,28,29 Hypotension can be exacerbated by the decrease in sodium reabsorption in the proximal tubule, characteristic of leptospirosis. After blood volume replacement, the clinical findings improve.…”

“…36,37,38 Experimental and clinical studies have shown that those findings result from injury to the proximal tubule and resistance of the medullary collecting tubule to vasopressin. 14,30,39 The injury of the proximal tubule leads to a reduction in the proximal reabsorption of sodium. The resistance of the medullary collecting tubule to vasopressin leads to a defect in the urinary concentration, causing polyuria.…”