Background. Renal involvement [as acute renal failure (ARF)] is a prominent feature of both mild and severe leptospirosis—a re‐emerging infectious disease. Few large series describe in detail clinical and laboratory features of cases with ARF and their outcome.
Methods. We performed a retrospective analysis (1997–2001) of all consecutive, serological confirmed leptospirosis cases with ARF (n=58, 53 male, age 44±13 years, rural residents=31%, animal contact=88%.
Results. Clinical manifestations (>50% prevalence): oliguria 95%, fever and jaundice 93%, nausea and vomiting 83%, haemorrhagic diathesis 80%, headache, hepatomegaly 76%, myalgias, abdominal pain 70%, hypotension 62%, disturbed consciousness 50%. A pattern of multiple organ failure (MOF) was frequent: ARF together with hepatic failure in 72%, respiratory failure in 38%, circulatory failure in 33%, pancreatitis in 25% and rhabdomyolysis in 5% of cases. Renal dysfunction: 35% of cases had a renal K+‐wasting defect and 43% a FENa+>1% and low‐osmolarity urine despite volume depletion. Haematuria was encountered in 12 and mild proteinuria in 10 subjects. Outcome: 26% deaths, 64% normal hepatic and renal function at 90 days from presentation (however 29% maintained the initial tubular defect), 10% persistent mild renal failure. All deceased patients had, beside ARF, at least two other organ failures, affected consciousness, and haemorrhagic diathesis vs a prevalence for the above features of only 34, 33, and 72%, respectively, in the survivors group (P<0.05).
Conclusions. Leptospirosis presenting with ARF is a severe disease, frequently leading to MOF and to death in one‐third of the patients. In particular, the haemorrhagic diathesis and cerebral involvement are markers for unfavourable patient and renal outcomes.
Keywords: acute renal failure; epidemiology; hepatic dysfunction; leptospirosis; multiple organ failure; outcome
Journal Article. 3976 words. Illustrated.
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