title: Renal magnesium wasting and tubular dysfunction in leptospirosis.
abstract: BACKGROUND
  Tubulo-interstitial nephritis is the main cause of acute renal injury in leptospirosis. The aim of this study was to evaluate renal tubular function and excretion of solutes in leptospirosis patients during a recent outbreak of leptospirosis in Nan province, Thailand.
  
  
  METHODS
  Clinical manifestations were recorded and routine laboratory tests were performed upon admission. Renal tubular functions including tubular reabsorption of phosphate (TRP), fractional excretion of magnesium (FE(Mg)), urinary calcium to creatinine ratio (Uca/cr), urine N-acetyl-beta-D glucosaminidase (NAG) and urine beta(2)-microglobulin were serially monitored during 2 weeks after admission.
  
  
  RESULTS
  A total of 20 leptospirosis patients were recruited. Nine (45%) patients had acute renal failure (ARF). Increased urine NAG and beta(2)-microglobulin, which indicate proximal tubular dysfunction, were demonstrated in all 20 (100%) patients. Fifteen (75%) patients had hypermagnesuria, whereas 10 (50%) patients had decreased TRP. Renal magnesium (Mg) and phosphate (P) wasting caused hypomagnesaemia and hypophosphataemia in nine and three patients with ARF, respectively. These abnormal findings significantly improved within 2 weeks after admission.
  
  
  CONCLUSIONS
  We conclude that renal Mg and P wasting commonly occur in patients with leptospirosis. The measurement of Mg and P levels in both serum and urine of leptospirosis patients, especially those with ARF, is therefore highly recommended.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
authors.forename: Sookkasem
authors.initials: S
authors.lastname: Khositseth
authors.forename: Niwatchai
authors.initials: N
authors.lastname: Sudjaritjan
authors.forename: Paiboon
authors.initials: P
authors.lastname: Tananchai
authors.forename: Sompong
authors.initials: S
authors.lastname: Ong-ajyuth
authors.forename: Visith
authors.initials: V
authors.lastname: Sitprija
authors.forename: Visith
authors.initials: V
authors.lastname: Thongboonkerd
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000652:urine; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D007684:Kidney Tubules / Q000378:metabolism* / Q000382:microbiology / Q000503:physiopathology*; D007919:Leptospira / Q000472:pathogenicity; D007922:Leptospirosis / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology*; D008274:Magnesium / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D010710:Phosphates / Q000378:metabolism; D011446:Prospective Studies; D013785:Thailand; D001613:beta 2-Microglobulin / Q000652:urine
chemical_list: D010710:Phosphates; D001613:beta 2-Microglobulin; D003404:Creatinine; D000118:Acetylglucosaminidase; D008274:Magnesium; D002118:Calcium