NDT Advance Access originally published online on October 19, 2007
Nephrology Dialysis Transplantation 2008 23(3):952-958; doi:10.1093/ndt/gfm698
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Renal magnesium wasting and tubular dysfunction in leptospirosis
1 Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand 2 Department of Medicine 3 Department of Clinical Pathology, Nan Hospital, Nan, Thailand 4 Department of Biochemistry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand 5 Queen Saovabha Memorial Institute, Bangkok, Thailand 6 Medical Molecular Biology Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Visith Thongboonkerd Medical Molecular Biology Unit, Office for Research and Development, 12th Floor Adulyadej Vikrom Building, Siriraj Hospital, 2 Pronnok Road, Bangkok 10700, Thailand. Phone/Fax: +66-2-4184793; E-mail: thongboonkerd{at}dr.com (or) vthongbo{at}yahoo.com
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Abstract |
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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 (FEMg), urinary calcium to creatinine ratio (Uca/cr), urine N-acetyl-β-D glucosaminidase (NAG) and urine β2-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 β2-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.
Keywords: leptospirosis; magnesium; nephropathy; renal failure; tubular dysfunction
Received for publication: 13. 5.07
Accepted in revised form: 10. 9.07