Abstract
BackgroundLeptospirosis is the most widespread zoonosis. Chronic human infection and asymptomatic colonization have been reported. However, renal involvement in those with leptospira chronic exposure remains undetermined.Methods and FindingsIn 2007, a multistage sampling survey for chronic kidney disease (CKD) was conducted in a southern county of Taiwan, an area with a high prevalence of dialysis. Additionally, an independent cohort of 88 participants from a leptospira-endemic town was followed for two years after a flooding in 2009. Risks of CKD, stages of CKD, associated risk factors as well as kidney injury markers were compared among adults with anti-leptospira antibody as defined by titers of microscopic agglutination test (MAT). Of 3045 survey participants, the individuals with previous leptospira exposure disclosed a lower level of eGFR (98.3±0.4 vs 100.8±0.6 ml/min per 1.73 m2, P<0.001) and a higher percentage of CKD, particularly at stage 3a-5 (14.4% vs 8.5%), than those without leptospira exposure. Multivariable linear regression analyses indicated the association of leptospiral infection and lower eGFR (95% CI -4.15 to -1.93, P < 0.001). In a leptospiral endemic town, subjects with a MAT titer ≥400 showed a decreased eGFR and higher urinary kidney injury molecule–1 creatinine ratio (KIM1/Cr) level as compared with those having lower titers of MAT (P<0.05). Furthermore, two participants with persistently high MAT titers had positive urine leptospira DNA and deteriorating renal function.Conclusions and SignificanceOur data are the first to show that chronic human exposure of leptospirosis is associated significantly with prevalence and severity of CKD and may lead to deterioration of renal function. This study also shed light on the search of underlying factors in areas experiencing CKD of unknown aetiology (CKDu) such as Mesoamerican Nephropathy.
Highlights
Chronic kidney disease (CKD) has an increasing prevalence worldwide [1]
Our data are the first to show that chronic human exposure of leptospirosis is associated significantly with prevalence and severity of CKD and may lead to deterioration of renal function
In this study we found that those individuals with previous leptospira exposure disclosed a lower renal function and a higher percentage of CKD
Summary
Chronic kidney disease (CKD) has an increasing prevalence worldwide [1]. According to the recent report on the global burden of diseases, there were 16.3 CKD-associated deaths per 100 000 individuals in 2010, ranking 18th in the list of 86 causes. Compared to its ranking of 27th in 1990, the rate of increasing has been only second to HIV and AIDS [2]. Diabetes and hypertension are the leading causes of CKD in all developed countries and in some developing countries [1,3]. Besides environmental and occupational exposure to chemicals, infections are important causes of renal failure [3]. Chronic human infection and asymptomatic colonization have been reported. Renal involvement in those with leptospira chronic exposure remains undetermined
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