The kidney in leptospirosis

Abstract

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.

Genotipificación y evaluación de la dinámica de infección de un aislamiento colombiano de Leptospira santarosai en el modelo experimental hámster

“…Estas alteraciones bioquímicas usualmente se presentan en casos de falla renal aguda, lo que, sumado a la deshidratación producida por un proceso infeccioso e inflamatorio sin reposición adecuada de líquidos, puede exacerbar el compromiso intrínseco renal ocasionado por la espiroqueta (35)(36)(37). Todas estas alteraciones son características del síndrome de Weil, en el que se generan cambios en hígado y riñón, los principales órganos blanco en la patogenia de la enfermedad (34-37).…”

Insuficiência renal aguda associada à leptospirose

“…Hypokalemia is the most Leptospirosis-associated acute kidney injury Adapted from Abdulkader & Silva. 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.…”

“…55 There is no consensus about the best dialysis modality for leptospirosis, and all modalities have already been used, including hemodialysis, peritoneal dialysis, and hemoperfusion. 56 A recent review of cases of leptospirosis associated with AKI in Thailand has shown that therapies such as hemodialysis and hemofiltration, when compared with standard peritoneal dialysis, associate with lower mortality, shorter time of recovery, and a faster reduction in the serum levels of bilirubin, urea, and creatinine. 57 …”

Leptospirosis in children: A review for family physicians

“…[3] In children, the risk factors for acquiring the disease include school-going age, exposure to ß ood waters, contact of bare feet with mud, wading through river, and contact with domestic animals. [12,13] There have been many recent reports on the seroprevalence and the clinical spectrum of the disease (including mild disease in children) from Indonesia, Vietnam, and Cambodia. [12,[14][15][16][17] In a study (from Cambodia), only 6 of 202 (i.e., 3%) cases of acute hemorrhagic fever in the study population (which included all age-groups) could be attributed to leptospiral infection.…”

“…[3,5,34] Degenerative changes, with hypertrophy and hyperplasia of Kupffer cells in the liver, diffuse tubulointerstitial inß ammation and tubular necrosis in the kidneys, and congestion with focal hemorrhages in the lungs, are the main histopathological features. [3,5,13,34] …”