A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature.
BACKGROUND
Renal involvement [as acute renal failure (ARF)] is a prominent feature of both mild and severe leptospirosis-a re-emerging infectious disease. Few large series describe in detail clinical and laboratory features of cases with ARF and their outcome.


METHODS
We performed a retrospective analysis (1997-2001) of all consecutive, serological confirmed leptospirosis cases with ARF (n=58, 53 male, age 44+/-13 years, rural residents=31%, animal contact=88%.


RESULTS
Clinical manifestations (>50% prevalence): oliguria 95%, fever and jaundice 93%, nausea and vomiting 83%, haemorrhagic diathesis 80%, headache, hepatomegaly 76%, myalgias, abdominal pain 70%, hypotension 62%, disturbed consciousness 50%. A pattern of multiple organ failure (MOF) was frequent: ARF together with hepatic failure in 72%, respiratory failure in 38%, circulatory failure in 33%, pancreatitis in 25% and rhabdomyolysis in 5% of cases. Renal dysfunction: 35% of cases had a renal K(+)-wasting defect and 43% a FE(Na)(+)>1% and low-osmolarity urine despite volume depletion. Haematuria was encountered in 12 and mild proteinuria in 10 subjects.


RESULTS
26% deaths, 64% normal hepatic and renal function at 90 days from presentation (however 29% maintained the initial tubular defect), 10% persistent mild renal failure. All deceased patients had, beside ARF, at least two other organ failures, affected consciousness, and haemorrhagic diathesis vs a prevalence for the above features of only 34, 33, and 72%, respectively, in the survivors group (P<0.05).


CONCLUSIONS
Leptospirosis presenting with ARF is a severe disease, frequently leading to MOF and to death in one-third of the patients. In particular, the haemorrhagic diathesis and cerebral involvement are markers for unfavourable patient and renal outcomes.
Covic
Adrian
A
Dialysis and Transplantation Center, C. I. Parhon University Hospital, Iasi, Romania. acovic@xnet.ro
Goldsmith
David J A
DJ
Gusbeth-Tatomir
Paul
P
Seica
Anca
A
Covic
Maria
M
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007902:Length of Stay; D007922:Leptospirosis / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008966:Moldova / Q000453:epidemiology; D009102:Multiple Organ Failure / Q000209:etiology; D012189:Retrospective Studies
D003404:Creatinine