Background: Acute kidney injury (AKI) occurs in 10 to 60% of patients with leptospirosis. The aim of this study is to investigate markers for oliguric AKI in leptospirosis. Methods: A retrospective study was performed with 196 consecutive patients with leptospirosis-associated AKI. These patients were categorized into either oliguric or non-oliguric according to their urine output. Clinical and laboratory characteristics were compared between the two groups. Results: Among these patients, 64 (32.6%) were oliguric and 132 (67.4%) nonoliguric. Markers for oliguria were age higher than 40 years (OR = 1.02, p = 0.04), hyponatremia (OR = 0.94, p = 0.03), elevated serum creatinine (OR = 1.11, p = 0.04), low arterial pH (OR = 1.0002, p = 0.01), high levels of AST (OR = 1.005, p = 0.01), crackles (OR = 3.83, p < 0.001) and direct bilirubin (OR = 1.03, p = 0.03). Elevated activated prothrombin time (OR = 0.97, p = 0.03) was a factor associated with nonoliguric AKI. Independent markers for oliguria were crackles (OR = 5.17, p = 0.0016) and direct bilirubin levels (OR = 1.051, p = 0.04). Mortality was significantly higher in oliguric than nonoliguric (27 vs. 8%, p < 0.001). Renal function at discharge was similar in oliguric and nonoliguric patients. Conclusion: Age higher than 40 years, hyponatremia, elevated serum creatinine, low arterial pH, high levels of AST, crackles and direct bilirubin levels would be useful to early identify patients with oliguric AKI in leptospirosis.

Everett ED: Microbiology, epidemiology, clinical manifestations, and diagnosis of leptospirosis.
Bharti AR, Nally JE, Ricaldi JN, et al: Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 2003;3:757–771.
Turhan V, Cavuslu S: Leptospirosis is still a mortal infection in even today’s world. Scand J Infect Dis 2006;38:746.
Istúriz RE, Torres J, Besso J: Global distribution of infectious diseases requiring intensive care. Crit Care Clin 2006;22:469–488.
Lomar AV, Veronesi R, Brito T, Diament D: Leptospiroses; in Veronesi R, Focaccia R (eds): Tratado de Infectologia, ed 2. São Paulo, Atheneu, 2002, pp 1007–1023.
Ko AI, Galvão Reis M, Ribeiro Dourado CM, et al: Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet 1999;354:820–825.
Visith S, Kearkiat P: Nephropathy in leptospirosis (Symposium). J Postgrad Med 2005;51:184–188.
Edwards CN, Nicholson GD, Hassel TA, Everard COR, Callender J: Leptospirosis in Barbados: a clinical study. West Indian Med J 1990;39:27–34.
Marotto PCF, Marotto MS, Santos DL, Souza TNL, Seguro AC: Outcome of leptospirosis. Am J Trop Med Hyg 1997;56:307–310.
Leblebiciouglu H, Sencan I, Sunbul M, Altintop I, Gunnaydin M: Weil’s disease: report of 12 cases. Scand J Infect Dis 1996;28:637–639.
Seguro AC, Lomar AV, Rocha AS: Acute renal failure in leptospirosis: nonoliguric and hypokalemic forms. Nephron 1990;55:146–151.
Abdulkader RCRM, Seguro AC, Malheiro PS, Burdmann EA, Marcondes M: Peculiar electrolytic and hormonal abnormalities in acute renal failure due to leptospirosis. Am J Trop Med Hyg 1996;54:1–6.
Tantitanawat S, Tanjatham S: Prognostic factors associated with severe leptospirosis. J Med Assoc Thai 2003;86:925–931.
Dupont H, Dupont-Perdrizet D, Perie JL, et al: Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis 1997;25:720–724.
Panaphut T, Domrongkitvhaiporn S, Thinkamrop B: Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand. Int J Infect Dis 2002;6:52–59.
Brady HR, Clarkson MR, Lieberthal W: Acute renal failure; in: Brenner & Rector’s The Kidney, ed 7. London, Elsevier, 2004, pp 1215–1292.
Kellum JA, Bellomo R, Ronco C: Classification of acute kidney injury using RIFLE: what’s the purpose? Crit Care Med 2007;35:1983–1984.
Daher EF, Nogueira CB: Evaluation of penicilin therapy in patients with leptospirosis and acute kidney injury. Rev Inst Med Trop São Paulo 2000;42:327–332.
Panaphut T, Domrongkitchaiporn S, Vibhagool A, et al: Ceftriaxone compared with sodium penicillin G for treatment of severe leptospirosis. Clin Infect Dis 2003;36:1507–1513.
Daher EF, Zanetta DM, Abdulkader RCRM: Pattern of renal function recovery after leptospirosis acute renal failure. Nephron Clin Pract 2004;98:8–14.
Heath CW, Alexander AD, Galton MM: Leptospirosis in the United States: analysis of 483 cases in man, 1949—1961. Part 2. N Engl J Med 1965;273:915–922.
Everard COR, Fraser-Chanpong GM, Everard JD: The incidence of severe leptospirosis in Trinidad. Trop Geogr Med 1987;39:126–132.
Sitprija V, Evans H: The kidney in human leptospirosis. Am J Med 1970;49:780–788.
Brivet FG, Kleinknecht DJ, Loirat P, Landais PJM: Acute renal failure in intensive care units. Causes, outcome and prognostic factors of hospital mortality: a prospective, multicenter study. Crit Care Med 1996;24:192–198.
Batista PB, Cendorogolo Neto M, dos Santos OF, Carvalho Bacelar AC, Batista Campos G, dos Santos ES: Evaluation of prognostic indexes in critical acute renal failure patients. Ren Fail 2004;26:545–552.
Silva GB Jr, Daher EF, Mota RMS, Menezes FA: Risk factors for death among critically ill patients with acute renal failure. São Paulo Med J 2006;124:257–263.
Daher EF, Zanetta DMT, Cavalcante M, Abdulkader RC: Risk factors for death and changing patterns in acute renal failure of leptospirosis. Am J Trop Med Hyg 1999;61:630–634.
Doudier B, Garcia S, Quennee V, Jarno P, Brouqui P: Prognostic factors associated with severe leptospirosis. Clin Microbiol Infect 2006;12:299–300.
Andrade L, Cleto S, Seguro A: Door-to-dialysis time and daily hemodialysis in patients with leptospirosis: impact on mortality. Clin J Am Soc Nephrol 2007;2:739–744.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.