Leptospirosis-Associated Acute Kidney Injury

Acute kidney injury (AKI) is a prominent feature of leptospirosis, characterized by tubulo-interstitial nephritis and tubular dysfunction. Nonoliguric hypokalemic form of AKI is a hallmark of leptospiral nephropathy. Arrhythmias are the most important cardiac manifestations of this disease, and they have been described as risk factors for death. The incidence of AKI in leptospirosis patients varies from 10 to 88%, depending on the definition of AKI, age, and severity of the disease. AKI diagnosis has been based on classification systems such as Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease, AKI network, and Kidney Disease Improving Global Outcome criteria. Studies using these criteria have demonstrated a clear correlation between these classifications and in-hospital mortality in leptospirosis patients. The Thai-Lepto-on-admission probability score, a clinical prediction score, might be applied at the point of care while awaiting confirmatory laboratory results. Urine and plasma neutrophil gelatinase-associated lipocalin appear to be useful markers for detecting AKI in patients with suspected leptospirosis. Early diagnosis and early antibiotic administration may rescue patients from multiple organ failure caused by leptospirosis. (c) 2019 S. Karger AG, Basel