Nephrol Dial Transplant (2003) 18: 1128-1134
© 2003 European Renal Association-European Dialysis and Transplant Association
A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature
1 Dialysis and Transplantation Center, ‘C. I. Parhon’ University Hospital, Iasi, Romania and 2 Renal Unit, Guy's Hospital, London, UK
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 FENa+>1% and low-osmolarity urine despite volume depletion. Haematuria was encountered in 12 and mild proteinuria in 10 subjects. Outcome: 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.
Keywords: acute renal failure; epidemiology; hepatic dysfunction; leptospirosis; multiple organ failure; outcome
Correspondence and offprint requests to: Dr Adrian Covic, MD, PhD, Associate Professor of Nephrology, Director, Dialysis Centre, Parhon Hospital, Bd Carol 1st, No. 50, Iasi, 6600, Romania. Email: acovic{at}xnet.ro
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