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Renal dysfunction in leptospirosis: a view from the tropics

Nature Clinical Practice Nephrology volume 2, pages 658–659 (2006)Cite this article

Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. It is characterized by a sudden onset of fever, myalgia and conjunctival injection. There is a broad spectrum of renal pathological changes;1 interstitial nephritis is the first to occur and can be observed in all patients, even those with normal renal function. Tubular necrosis with acute renal failure (ARF) is a life-threatening complication of leptospirosis. The pathogenesis of renal lesions includes bacterial invasion, toxicity of bacterial products, effects of proinflammatory cytokines and mediators, and hemodynamic alterations.1,2 Renal dysfunction ranges from prerenal azotemia to severe ARF requiring renal replacement therapy. The incidence of ARF varies widely but can be as high as 40–60% of patients with severe leptospirosis.

Hypotension (mean arterial pressure <70 mmHg), representing moderate to severe disease, is noted in 60% of people with leptospirosis.3 A patient with leptospirosis can be fully conscious despite the presence of hypotension, but can rapidly develop ARF and lung complications, and die within 5–6 h of admission to the hospital. The term 'leptospirosis triad' was coined to describe a syndrome of hypotension, ARF and pulmonary complications that occurs in 20% of patients with this disease. Pulmonary complications, which include pulmonary edema, acute respiratory distress syndrome, pulmonary hemorrhage and pneumonitis, are less common in normotensive patients than in hypotensive patients. Therefore, in addition to antimicrobial therapy (the cornerstone of leptospirosis management), prompt treatment of hypotension is desirable. It is important to bear in mind, however, that excessive fluid administration can lead to fluid overload. Hypotensive patients are at particularly high risk of developing pulmonary edema following excessive intravenous fluid administration. As hypotension is an important determinant of complications in leptospirosis, the role of hemodynamics in this condition deserves consideration.

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  1. Chulalongkorn University Medical School and Director of the Queen Saovabha Memorial Institute, Bangkok, Thailand

    Visith Sitprija

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  1. Visith Sitprija
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Correspondence to Visith Sitprija.

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Sitprija, V. Renal dysfunction in leptospirosis: a view from the tropics. Nat Rev Nephrol 2, 658–659 (2006). https://doi.org/10.1038/ncpneph0326

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