Renal involvement is common in
leptospirosis. Bacterial invasion, inflammatory process, haemodynamic alterations and direct toxicity of bacterial products are thought to be responsible for the development of nephropathy. Pathologically, all renal structures are involved.
Interstitial nephritis is the basic lesion, and is observed even in patients without clinical renal manifestations. Tubular
necrosis is the important pathological counterpart of
acute renal failure. The clinical spectrum of renal manifestations includes mild urinary sediment change,
hypokalemia, tubular dysfunction, decreased response to fluid load and
acute renal failure (ARF). ARF reflects the severity of
leptospirosis, is catabolic and is commonly associated with
cholestatic jaundice. Severe
renal failure may be complicated by multiple organ involvement.
Renal failure with
hyperbilirubinemia represents a severe form of renal dysfunction with oligo-
anuria and prolonged
clinical course. Mild
renal failure is usually anicteric and non-oliguric and without complication. Besides
antibiotic treatment, early and frequent dialysis is life saving. ARF with major organ failure has unfavorable outcome.
Plasmapheresis and
continuous venovenous hemofiltration improve hemodynamics and are beneficial for the patients with
acute renal failure and multiorgan involvement. Recovery of renal function is usually complete in most patients.