Insuficiência renal aguda associada à leptospirose

Abstract

Leptospirosis is the most important zoo- nosis in the world. Patients are typically young men. Several factors are involved in acute kidney injury (AKI) in leptospiro- sis, including direct nephrotoxic action of the leptospira, hyperbilirubinemia, rhab- domyolysis and hypovolemia. The major histological findings are acute intersti- tial nephritis and acute tubular necrosis. Leptospirosis-induced AKI is usually non- oliguric and hypokalemic. Tubular func- tion abnormalities precede a decline in the glomerular filtration rate, which could explain the high frequency of hypokale- mia. Antibiotic treatment is efficient in the early and late and/or severe phases. For critically ill leptospirosis patients, the following measures are recommended: early and daily hemodialysis; low volume infusion (due to the risk of pulmonary he- morrhage); and lung-protective strategies. Mortality in leptospirosis-associated AKI is around 22%.