Abstract
AKI is one of the most serious complications of leptospirosis, an important zoonosis in the tropics. Recently, NGAL, one of the novel AKI biomarkers, is extensively studied in various specific settings such as sepsis, cardiac surgery, and radiocontrast nephropathy. In this multicenter study, we aimed to study the role of NGAL as an early marker and an outcome predictor of leptospirosis associated AKI. Patients who presented with clinical suspiciousness of leptospirosis were prospectively enrolled in 9 centers from August 2012 to November 2014. The first day of enrollment was the first day of clinical suspicious leptospirosis. Blood and urine samples were serially collected on the first three days and day 7 after enrollment. We used three standard techniques (microscopic agglutination test, direct culture, and PCR technique) to confirm the diagnosis of leptospirosis. KDIGO criteria were used for AKI diagnosis. Recovery was defined as alive and not requiring dialysis during hospitalization or maintaining maximum KDIGO stage at hospital discharge. Of the 221 recruited cases, 113 cases were leptospirosis confirmed cases. Thirty seven percent developed AKI. Median uNGAL and pNGAL levels in those developing AKI were significantly higher than in patients not developing AKI [253.8 (631.4) vs 24.1 (49.6) ng/ml, p < 0.001] and [1,030 (802.5) vs 192.0 (209.0) ng/ml, p < 0.001], respectively. uNGAL and pNGAL levels associated with AKI had AUC-ROC of 0.91, and 0.92, respectively. Both of urine NGAL and pNGAL level between AKI-recovery group and AKI-non recovery were comparable. From this multicenter study, uNGAL and pNGAL provided the promising result to be a marker for leptospirosis associated AKI. However, both of them did not show the potential role to be the predictor of renal recovery in this specific setting.
Highlights
Leptospirosis is an important zoonosis especially in the tropics
We examined whether uNGAL and pNGAL level associated with Acute Kidney Injury (AKI) and predicted renal non-recovery in a multivariable model adjusting for clinical parameters
Focusing on the predicting model for AKI and renal recovery in all cases, we found uNGAL and pNGAL independently associated with AKI, odds ratio (OR) 18.1, P = 0.009, and odds ratios (OR) 1.59 (1.28–1.97), P < 0.001, respectively) (Table 4A)
Summary
Leptospirosis is an important zoonosis especially in the tropics. with the impact of world globalization, there are reports of this disease as sporadic cases in developed countries. The incidence of AKI in leptospirosis by using the RIFLE AKI criteria was up to 84% [2] This is higher than the average AKI incidence in the Intensive Care Unit (ICU) [3] and more than twice as high as seen in patients with community acquired pneumonia in the US [4]. In this specific setting the kidney is injured by direct effects (direct invasion of the organism) and by indirect effects such as dehydration, rhabdomyolysis, and hemorrhagic shock [5]. Benefits from biomarkers to predict AKI in leptospirosis would include early triage patients from primary hospital to tertiary care facilities, early treatment interventions such as fluid resuscitation, optimizing tissue oxygenation and perfusion possibly preventing AKI progression, and early discontinuation of nephrotoxic drugs
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