title: Potential benefit of plasma exchange in treatment of severe icteric leptospirosis complicated by acute renal failure.
abstract: Leptospirosis is a common zoonosis seen worldwide, but it is rare in our locality (Hong Kong). Clinical manifestations of leptospirosis are variable and may range from subclinical infection to fever, jaundice, hemorrhagic tendency, and fulminant hepato-renal failure. Severe hyperbilirubinemia and acute renal failure have been associated with high mortality. We report our experience with a patient who developed severe Weil's syndrome with marked conjugated hyperbilirubinemia and oliguric acute renal failure. These complications persisted despite treatment with penicillin and hemodiafiltration. Plasma exchange was instituted in view of the severe hyperbilirubinemia (970 micromol/liter). This was followed by prompt clinical improvement, with recovery of liver and renal function. The beneficial effects of plasma exchange could be attributed to amelioration of the toxic effects of hyperbilirubinemia on hepatocyte and renal tubular cell function. We conclude that plasma exchange should be considered as an adjunctive therapy for patients with severe icteric leptospirosis complicated by acute renal failure who have not shown rapid clinical response to conventional treatment.
authors.affiliation: Nephrology Division, Department of Medicine, University of Hong Kong.
authors.forename: Kai-Chung
authors.initials: KC
authors.lastname: Tse
authors.forename: Pok-Siu
authors.initials: PS
authors.lastname: Yip
authors.forename: King-Men
authors.initials: KM
authors.lastname: Hui
authors.forename: Fu-Keung
authors.initials: FK
authors.lastname: Li
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
authors.forename: Kar-Neng
authors.initials: KN
authors.lastname: Lai
authors.forename: Tak-Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D058186:Acute Kidney Injury / Q000382:microbiology*; D000328:Adult; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications / Q000382:microbiology / Q000628:therapy; D007565:Jaundice / Q000150:complications / Q000382:microbiology / Q000628:therapy; D008297:Male; D010951:Plasma Exchange; D014895:Weil Disease / Q000150:complications* / Q000628:therapy*