Failure In Leptospirosis Research Articles

A Life Saving Exchange: A Case of Severe Direct Hyperbilirubinemia And Liver Failure in Leptospirosis Successfully Treated with Plasma Exchange

Leptospirosis is an infection with multiorgan involvement and a high mortality rate. Extreme hyperbilirubinemia in leptospirosis has been reported to exert multiple cellular toxic effects on kidney and liver cells. We describe a young man with leptospirosis who had extreme hyperbilirubinemia, acute liver injury, coagulopathy, hepatic encephalopathy, and pulmonary haemorrhages. Early initiation of therapeutic plasma exchange (PEX) dramatically improved patient’s clinical and biochemical parameters. We conclude that, in addition to the mortality benefit provided by PEX in severe pulmonary hemorrhage syndrome in leptospirosis, PEX is also beneficial in reducing systemic toxic insults of hyperbilirubinemia.

POS-179 LEPTOSPIROSIS ASSOCIATED ACUTE KIDNEY INJURY: A FIVE-YEAR EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Leptospirosis is the most widespread zoonotic disease in the world and one of the main tropical infection causing acute kidney injury (AKI). The coastline states of India are most endemic to leptospirosis. Acute kidney injury is one of the most serious complications of leptospirosis and mortality rates varies according to the clinical presentation and usually increases when kidney injury is present. Early recognition helps clinicians to act fast and prevent mortality due to renal failure in Leptospirosis.

Leptospiral Acute Renal Failure: Effects of Dopamine and Furosemide

From unpublished experience of clinicians in the rural tropics, the combination of furosemide and dopamine is beneficial in the management of mild acute renal failure in tropical disease. We studied two groups of patients with leptospirosis and mild acute renal failure whose serum creatinine ranged from 2.4 to 5 mg/dL and fractional excretion of sodium varied from 1.21 to 2.08%. Group 1, consisting of 9 patients with the serum creatinine ranging from 2.4 to 5 mg/dL, served as the control. They received only penicillin G sodium and supportive treatment. Group 2, consisting of 8 patients with the serum creatinine ranging from 2.8 to 5 mg/dL, received, in addition to penicillin, dopamine (renal dose) and furosemide along with fluid and electrolyte replacement. The control group ran the usual clinical course of acute renal failure, and 3 patients required dialysis. There was profuse diuresis, and the recovery of renal function was faster in group 2 patients. Dopamine and furosemide are therefore useful in mild acute renal failure in leptospirosis. It is felt that this combination could be beneficial in the management of mild acute ischemic renal failure due to a clean single insult.

Can rhabdomyolysis be the only cause of acute renal failure in leptospirosis?

Can rhabdomyolysis be the only cause of acute renal failure in leptospirosis?

Acute renal failure in leptospirosis in the black-sea region in Turkey.

Leptospirosis is an infectious disease caused by pathogenic leptospires and is characterized by a broad spectrum of clinical manifestations, varying from inappearent infection to fulminant, fetal disease. Eighty-five to 90% of leptospirosis infections are self-limiting. However, 5-10% of infection by L. interrogans can cause renal tubular damage, microvascular injury, acute renal failure (ARF), and interstitial nephritis. We studied 36 patients with leptospirosis. Twenty-seven (65%) cases of 36 patients had ARF. Fourteen (51%) had nonoliguric ARF. In thirteen (48%) oliguria appeared on the third or fourth days of hospitalization. Serum BUN, creatinine, serum bilirubine, ALT, AST, potassium and thrombocytopenia levels were higher in oliguric than nonoliguric patients (p < 0.05). However, serum sodium, CPK levels were not different between oliguric and nonoliguric groups (p > 0.05). Thirteen patients (48%) needed in renal replacement therapy (RRT). 8 of them were treated by hemodialysis (HD) alone and 5 patients by HD in combination with hemoperfusion. Twenty-five patients (92%) recovered completely after 3-5 weeks. Two patients (7.4%) who had severe hepatorenal and hemorrhagic syndromes, died. We concluded that till now leptospirosis is actual problem for nephrologist in the developing countries because of very high percentage of renal disease, with good prognosis in patients without multiorgan failure and early treatment.

Acute lung injury in leptospirosis: clinical and laboratory features, outcome, and factors associated with mortality.

Forty-two consecutive patients with leptospirosis and acute lung injury who were mechanically ventilated were analyzed in a prospective cohort study. Nineteen patients (45%) survived, and 23 (55%) died. Multivariate analysis revealed that 3 variables were independently associated with mortality: hemodynamic disturbance (odds ratio [OR], 6.0; 95% confidence interval [CI], 0.9-38.8; P=. 047), serum creatinine level >265.2 micromol/L (OR, 10.6; 95% CI, 0. 9-123.7; P =.026), and serum potassium level >4.0 mmol/L (OR, 19.9; 95% CI, 1.2-342.8; P=.009). These observations can be used to identify factors associated with mortality early in the course of severe respiratory failure in leptospirosis.

Acute Renal Failure in Leptospirosis

Leptospirosis acute renal failure is reviewed: its prevalence, clinical characteristics, physiopathologic mechanisms, histology, mortality, follow-up, prophylaxis, and treatment.

Acute Renal Failure in Leptospirosis in Uruguay

The present study was carried out to describe epidemiology and clinical pattern of acute renal failure caused by leptospirosis in Uruguay. For these purposes, all literature published in Uruguay was reviewed. Three studies were analyzed: 2 series of patients and 1 case report that summarize 26 cases. The incidence of acute renal failure found in the first study was 8% and in the second one, 15%. The first study included only dialyzed patients, which could explain the aforementioned difference. The estimated annual incidence of leptospirosis in Uruguay is about 10 cases/year. Therefore, the expected incidence of acute renal failure due to leptospirosis is of 0.7–1.3 cases/year. All but I case were males. Mean age was 35 ± 14.5. Source of infection was known in 23/26. Typical symptoms were: fever 26/26, myalgias 22/26, dehydration 21/26, jaundice 21/26, conjuntival suffusion 20/26, and digestive disturbance 18/26. Bleeding and meningitis were infrequent (8/26, 5/26, respectively). Acute renal failure was intrinsic in 18/26. Nonoliguric forms were predominant (14/18). Kalemia was low or normal in 22/26 cases. Dialysis was performed in 9/26 cases, but the number of dialyses per patient was high (9.4 ± 4). The survival rate was 23/26. We concluded that leptospirosis is an infrequent cause of acute renal failure in Uruguay, with an expected frequency of approximately 1 case/year. Clinical picture was typical and contact was frequently known, which made diagnosis easy. Acute renal failure was predominantly polyuric and with low or normal kalemia; survival rate was high.

Respiratory failure in leptospirosis (Weil's disease)

Two patients with leptospirosis (Weil's disease), with acute respiratory failure necessitating mechanical ventilation, are described. Adult respiratory distress syndrome (ARDS) in one patient and profuse pulmonary bleeding in the other were the respective causes of respiratory failure. One patient died after developing the multiple organ dysfunction syndrome (MODS), the other patient recovered completely. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary bleeding and/or ARDS.

Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis?

Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120 micrograms/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.

Renal involvement in leptospirosis: a pathophysiologic study.

The kidney involvement in leptospirosis appears to be a special form of acute renal failure due to a higher frequency of polyuric forms and the presence of hypokalemia with an elevated urinary fractional excretion of potassium. Using a clearance technique, we detected higher fractional urinary potassium excretion in leptospirotic guinea pigs (26.5 +/- 4.7%) than in normal animals (14.1 +/- 2.8%, p < 0.05). After blocking distal NaCl reabsorption with furosemide, it was observed that in leptospirotic animals both fractional sodium excretion (40.0 +/- 7.4%) and fractional potassium excretion (136.3 +/- 32.7%) were higher than in normal animals (20.4 +/- 3.8%, p < 0.05, and 43.6 +/- 9.0%, p < 0.05, respectively). Microperfusion studies showed that the normal and leptospirotic medullary thick ascending limb had both identical transepithelial potential difference (+3.7 +/- 0.4 vs. 3.9 +/- 0.2 mV) and relative sodium-to-chloride permeability. The same technique showed that the osmotic water permeability (Posm; 0.9 +/- 0.4 x 10(-5) cm/s.atm) and diffusional permeability (34.7 +/- 6.6 x 10(-5) cm/s) observed in the leptospirotic inner medullary collecting duct (IMCD) in the presence of vasopressin were unchanged, as was also the case for urea permeability (3.74 +/- 0.7 x 10(-5) cm/s). These data show that acute renal failure in leptospirosis is characterized by tubular changes leading to potassium secretion probably due to a decrease in proximal sodium reabsorption. Furthermore, the inability to concentrate urine evidenced by the low P(o)sm present in leptospirotic animals is due, at least in part, to IMCD resistance to vasopressin.

Urgent hemosorption in leptospirosis.

Resistant oliguria with increasing serum creatine phosphokinase (CPK) level are the most important early signs of the development of acute renal failure in leptospirosis. This symptomocomplex must be considered as indication for urgent hemosorption. Diuresis and normalisation of creatine phosphokinase level are the criteria for accessing the efficiency of hemosorptions.

Thrombocytopenia and Renal Failure in Leptospirosis

In a retrospective study of 60 cases of leptospirosis, the association of thrombocytopenia and acute renal failure as previously reported was confirmed. However, increased mortality, in our experience, was not associated with either thrombocytopenia or acute renal failure.

Acute renal failure in leptospirosis.

Although renal failure is an infrequent manifestation of leptospirosis occurring in 10% of cases, it is important because it is the main factor resulting in the overall mortality of 5%.