Leptospirosis

An ignored cause of acute renal failure in Taiwan

Chih Wei Yang, Ming Jeng Pan, Mai Szu Wu, Yu Ming Chen, Yu Tang Tsen, Chun Liang Lin, Cheng Hung Wu, Chiu Ching Huang

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Leptospirosis, caused by a spirochete, is the most common zoonosis in domestic or wild animals. Animals excrete infected urine in soil or water and may cause human infections through abrased wound, mucosa, conjunctiva, or by swallowing contaminated water. Clinical presentations of leptospirosis are mostly subclinical. Five to ten percent of leptospirosis are fatal, causing fever, hemorrhage, jaundice, and acute renal failure (Weil's syndrome). Leptospirosis has been ignored as a cause of acute renal failure in Taiwan. We report two patients with leptospirosis who presented with high fever, abdominal pain, jaundice, and acute renal failure. Patient 1 died on day 12 of admission of multiple organ failure associated with pancytopenia, hypogammaglobulinemia, and reactive hemophagocytosis. Leptospirosis was recognized after death. Patient 2 was admitted with similar presentations 2 weeks later. Penicillin and doxycycline were given early in the course, and azotemia, jaundice, respiratory failure, and aseptic meningitis gradually improved. Renal biopsy showed interstitial nephritis. Several tubular clearance tests showed proximal tubular defect with severe bicarbonate wasting (FeHCO3 - 20.9%) and incomplete type II renal tubular acidosis without affecting the distal nephron. After 80 days of treatment, this patient was discharged with recovery of conscious level and renal function. This is the first leptospirosis patient with detailed tubular functional and morphological studies of the kidney. Diagnosis of leptospirosis was made by microscopic agglutination test (MAT) for antibody to leptospira and by polymerase chain reaction (PCR) for leptospira DNA in blood and urine (interrogans serogroup australis in case 1 and Leptospira borgpetersenii serogroup ballum in case 2). Because active surveillance has resulted in 13 cases diagnosed as leptospirosis islandwide thereafter, underestimation and ignorance of leptospirosis as a cause of acute renal failure may occur in Taiwan. Therefore, an area with a low leptospirosis incidence may actually have a very high incidence. Leptospirosis should be suspected in febrile patients with jaundice and renal failure when pathogens cannot be identified by traditional culture for microorganisms.

Original languageEnglish
Pages (from-to)840-845
Number of pages6
JournalAmerican Journal of Kidney Diseases
Volume30
Issue number6
Publication statusPublished - Dec 1997
Externally publishedYes

Fingerprint

Leptospirosis
Taiwan
Acute Kidney Injury
Jaundice
Leptospira
Fever
Kidney
Urine
Renal Tubular Acidosis
Azotemia
Aseptic Meningitis
Agammaglobulinemia
Interstitial Nephritis
Spirochaetales
Agglutination Tests
Pancytopenia
Wild Animals
Multiple Organ Failure
Water
Doxycycline

Keywords

  • Acute renal failure
  • Interstitial nephritis
  • Leptospirosis

ASJC Scopus subject areas

  • Nephrology

Cite this

Yang, C. W., Pan, M. J., Wu, M. S., Chen, Y. M., Tsen, Y. T., Lin, C. L., ... Huang, C. C. (1997). Leptospirosis: An ignored cause of acute renal failure in Taiwan. American Journal of Kidney Diseases, 30(6), 840-845.

Leptospirosis : An ignored cause of acute renal failure in Taiwan. / Yang, Chih Wei; Pan, Ming Jeng; Wu, Mai Szu; Chen, Yu Ming; Tsen, Yu Tang; Lin, Chun Liang; Wu, Cheng Hung; Huang, Chiu Ching.

In: American Journal of Kidney Diseases, Vol. 30, No. 6, 12.1997, p. 840-845.

Research output: Contribution to journalArticle

Yang, CW, Pan, MJ, Wu, MS, Chen, YM, Tsen, YT, Lin, CL, Wu, CH & Huang, CC 1997, 'Leptospirosis: An ignored cause of acute renal failure in Taiwan', American Journal of Kidney Diseases, vol. 30, no. 6, pp. 840-845.
Yang CW, Pan MJ, Wu MS, Chen YM, Tsen YT, Lin CL et al. Leptospirosis: An ignored cause of acute renal failure in Taiwan. American Journal of Kidney Diseases. 1997 Dec;30(6):840-845.
Yang, Chih Wei ; Pan, Ming Jeng ; Wu, Mai Szu ; Chen, Yu Ming ; Tsen, Yu Tang ; Lin, Chun Liang ; Wu, Cheng Hung ; Huang, Chiu Ching. / Leptospirosis : An ignored cause of acute renal failure in Taiwan. In: American Journal of Kidney Diseases. 1997 ; Vol. 30, No. 6. pp. 840-845.
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