title: Urinary diagnostic indices in the management of leptospirosis. Selection of patients for dialysis therapy.
abstract: Cases of leptospirosis admitted to the Queen Elizabeth Hospital (QEH), Barbados, were assessed for the presence of "pre-renal azotaemia" (NON-ARF) as opposed to "acute renal failure" (ARF). Distinction between the two diagnoses was made on the basis of clinical course. Peritoneal dialysis was inappropriately utilised in 26% of patients receiving such therapy. This study evaluates diagnostic tests for pre-renal azotaemia, and acute renal failure in leptospirosis, and indicates guidelines for the management of azotaemia in such patients. U/P urea and osmolar ratios show high sensitivity and specificity in diagnosing pre-renal azotaemia. While "early" dialysis is essential for patients with acute leptospiral renal failure, in those with plasma creatinines less than 600 mumol/litre on entry and indices indicating NON-ARF, decisions regarding dialysis can safely be delayed for 48-72 hours while the effect of rehydration is assessed.
authors.forename: G D
authors.initials: GD
authors.lastname: Nicholson
authors.forename: C N
authors.initials: CN
authors.lastname: Edwards
authors.forename: T A
authors.initials: TA
authors.lastname: Hassell
authors.forename: C O
authors.initials: CO
authors.lastname: Everard
authors.forename: J
authors.initials: J
authors.lastname: Callender
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy / Q000652:urine*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D014511:Uremia / Q000209:etiology / Q000628:therapy / Q000652:urine*