Journal Article

Renal magnesium wasting and tubular dysfunction in leptospirosis

Sookkasem Khositseth, Niwatchai Sudjaritjan, Paiboon Tananchai, Sompong Ong-ajyuth, Visith Sitprija and Visith Thongboonkerd

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 3, pages 952-958
Published in print March 2008 | ISSN: 0931-0509
Published online October 2007 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfm698
Renal magnesium wasting and tubular dysfunction in leptospirosis

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Background. Tubulo-interstitial nephritis is the main cause of acute renal injury in leptospirosis. The aim of this study was to evaluate renal tubular function and excretion of solutes in leptospirosis patients during a recent outbreak of leptospirosis in Nan province, Thailand.

Methods. Clinical manifestations were recorded and routine laboratory tests were performed upon admission. Renal tubular functions including tubular reabsorption of phosphate (TRP), fractional excretion of magnesium (FEMg), urinary calcium to creatinine ratio (Uca/cr), urine N-acetyl-β-d glucosaminidase (NAG) and urine β2-microglobulin were serially monitored during 2 weeks after admission.

Results. A total of 20 leptospirosis patients were recruited. Nine (45%) patients had acute renal failure (ARF). Increased urine NAG and β2-microglobulin, which indicate proximal tubular dysfunction, were demonstrated in all 20 (100%) patients. Fifteen (75%) patients had hypermagnesuria, whereas 10 (50%) patients had decreased TRP. Renal magnesium (Mg) and phosphate (P) wasting caused hypomagnesaemia and hypophosphataemia in nine and three patients with ARF, respectively. These abnormal findings significantly improved within 2 weeks after admission.

Conclusions. We conclude that renal Mg and P wasting commonly occur in patients with leptospirosis. The measurement of Mg and P levels in both serum and urine of leptospirosis patients, especially those with ARF, is therefore highly recommended.

Keywords: leptospirosis; magnesium; nephropathy; renal failure; tubular dysfunction

Journal Article.  5378 words. 

Subjects: Nephrology

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