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      Pattern of Renal Function Recovery after Leptospirosis Acute Renal Failure

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          Background: Although acute renal failure (ARF) is a frequent complication of severe leptospirosis, there are few studies on renal function recovery in the literature. The objective of the present study was to verify how and when renal function recovery occurs after leptospirosis ARF. Patients and Methods: 35 patients with leptospirosis ARF (plasma creatinine [P<sub>creat</sub>] ≧133 µmol/l at hospital admission) were prospectively studied during hospitalization, at discharge and 3 and 6 months after discharge. Creatinine clearance, fractional excretion of sodium and potassium, proteinuria and sodium proximal reabsorption were measured under normal sodium diet. Urinary pH and the ratio urinary to plasma osmolality (U/P<sub>osm</sub>) were measured 18 h after food and water withdrawal. All parameters were also measured in 18 healthy volunteers. Presence of laboratorial alterations usually found in leptospirosis were evaluated in the patients. Patients were divided in 2 groups according to their maximum P<sub>creat</sub> value during hospitalization: group 1 ( P<sub>creat</sub> >442 µmol/l, n = 21), and group 2 (P<sub>creat</sub> ≤442 µmol/l, n = 14). Results: All patients presented with jaundice, fever and myalgia. Bilirubin and creatine kinase were higher in group 1. Oliguria was observed in 11% of all patients and 49% required dialysis; all these patients were from group 1. All renal parameters were normal at the 6th month except U/P<sub>osm</sub> that remained lower than normal. The pattern of renal function recovery was similar in both groups except for urinary volume. Conclusion: After leptospirosis ARF, renal function recovery is fast and complete after 6 months, except for urinary concentration capacity.

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          Acute lung injury in leptospirosis: clinical and laboratory features, outcome, and factors associated with mortality.

          Forty-two consecutive patients with leptospirosis and acute lung injury who were mechanically ventilated were analyzed in a prospective cohort study. Nineteen patients (45%) survived, and 23 (55%) died. Multivariate analysis revealed that 3 variables were independently associated with mortality: hemodynamic disturbance (odds ratio [OR], 6.0; 95% confidence interval [CI], 0.9-38.8; P=. 047), serum creatinine level >265.2 micromol/L (OR, 10.6; 95% CI, 0. 9-123.7; P =.026), and serum potassium level >4.0 mmol/L (OR, 19.9; 95% CI, 1.2-342.8; P=.009). These observations can be used to identify factors associated with mortality early in the course of severe respiratory failure in leptospirosis.
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            Reversible Proximal Tubular Dysfunction in a Patient with Acute Febrile Illness, Marked Hyperbilirubinemia and Normal Renal Function: Evidence of Leptospirosis


              Author and article information

              Nephron Clin Pract
              Nephron Clinical Practice
              S. Karger AG
              September 2004
              17 November 2004
              : 98
              : 1
              : c8-c14
              aHospital Walter Cantídio, School of Medicine, Federal University of Ceará, Fortaleza, CE; bSão José do Rio Preto Medical School, São José do Rio Preto, SP; cHospital das Clínicas, Nephrology Division, University of São Paulo Medical School, São Paulo, SP, Brazil
              79922 Nephron Clin Pract 2004;98:c8–c14
              © 2004 S. Karger AG, Basel

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              Tables: 3, References: 25, Pages: 1
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