Login




Nefrologia clinica

Acute renal failure in Weil’s disease

Questo Abstract è stato accettato come Poster. Clicca qui per visualizzare

Razionale

Leptospirosis is an emerging worldwide zoonotic disease. The most severe form of leptospirosis is Weil’s disease, characterized by jaundice, acute kidney injury (AKI), hypotension, pulmonary oedema and haemorrhage, most commonly involving lungs but also potentially affecting gastrointestinal tract, retroperitoneum, pericardium and brain. Mortality in leptospirosis-AKI is around 22%.

Casistica e Metodi

A 74-year-old Caucasian male was admitted because of fever, anuria and mialgia lasting for 2 days, dyspnoea and jaundice without dermatological findings. No history of renal disease. A month earlier he had travelled to a region of Southern Italy. Creatinine 5.25, potassium 3.3, procalcitonin 45.71, PCR 22.70, ferritin 1300, platelets 13,000, T/D bilirubin 4.3 / 2.1. Immunological and microbiological tests:unremarkable. Chest X-ray: multiple bilateral ground-glass opacities. Thoracic CT-scan: multiple bilateral consolidations and bilateral pleural effusion (Fig. 1A). An abdominal ultrasonography and a CT-scan revealed no abnormalities. Two days after admission we observed melena and worsening of liver function (T/D bilirubin 17.3 /10.5). Abdomen CT-scan highlighted greatly thickened gallbladder and bile duct walls, peritoneal effusion and swelling of the visceral adipose tissue (Fig. 1B). We performed Leptospira IgM test with positive result.

Risultati

We started haemofiltration and platelets transfusion, diuretic, ceftazidime and prednisone therapy with rapid regression of dyspnoea and progressive improvement of general conditions; 10 days after admission we stopped haemofiltration. The patient was discharged on day 18: creatinine: 0.93.

Conclusioni

Leptospirosis is an infectious vasculitis. Renal impairment is a frequent complication in Weil's disease. It may vary from sub-clinical course with mild proteinuria and urinary sediment changes to severe renal failure. All renal structures are involved but interstitial nephritis is the basic lesion. Hypokalaemia is the most characteristic laboratory finding. Leptospirosis-AKI can also have a prerenal component. Prognosis is usually favourable unless complicated by multiple organ involvement.

G. Li Cavoli, C. Zagarrigo, F. Servillo, O. Schillaci, A. Tralongo, M. Coglitore, C. Tortorici, L. Bono, A. Ferrantelli, C. Giammarresi, U. Rotolo
(Nephrology and Dialysis Civic and Di Cristina Hospital, Palermo Italy)
Non sono presenti commenti
Figure
Realizzazione: Tesi S.p.A.

Per assistenza contattare: Lucia Piumetto, Tesi S.p.A.
0172 476301 — lucia.piumetto@gruppotesi.com