Original Article A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature

Background. Renal involvement [as acute renal failure (ARF)] is a prominent feature of both mild and severe leptospirosis—a re-emerging infectious disease. Few large series describe in detail clinical and laboratory features of cases with ARF and their outcome. Methods. We performed a retrospective analysis (1997–2001) of all consecutive, serological confirmed leptospirosis cases with ARF (ns58, 53 male, age 44" 13 years, rural residentss31%, animal contacts88%. Results. Clinical manifestations ()50 % prevalence): oliguria 95%, fever and jaundice 93%, nausea and vomiting 83%, haemorrhagic diathesis 80%, headache, hepatomegaly 76%, myalgias, abdominal pain 70%, hypotension 62%, disturbed consciousness 50%. A pattern of multiple organ failure (MOF) was frequent: ARF together with hepatic failure in 72%, respiratory failure in 38%, circulatory failure in 33%, pancreatitis in 25 % and rhabdomyolysis in 5 % of cases. Renal dysfunction: 35 % of cases had a renal Kq-wasting defect and 43 % a FENa q)1 % and low-osmolarity urine despite volume depletion. Haematuria was encoun-tered in 12 and mild proteinuria in 10 subjects. Outcome: 26 % deaths, 64 % normal hepatic and renal function at 90 days from presentation (however 29% maintained the initial tubular defect), 10 % persistent mild renal failure. All deceased patients had, beside ARF, at least two other organ failures, affected con-sciousness, and haemorrhagic diathesis vs a prevalence for the above features of only 34, 33, and 72%, respectively, in the survivors group (P-0.05). Conclusions. Leptospirosis presenting with ARF is a severe disease, frequently leading to MOF and to death in one-third of the patients. In particular, the haemor-rhagic diathesis and cerebral involvement are markers for unfavourable patient and renal outcomes