A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature
A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature
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DOI：
10.1093/ndt/gfg095
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发表时间：
2003-06-01
影响因子：
6.1
通讯作者：
Covic, M
中科院分区：
文献类型：
--
作者：
Covic, A;Goldsmith, DJA;Covic, M
背景肾脏受累[如急性肾衰竭（ARF）]是轻度和重度钩端螺旋体病（一种重新出现的传染病）的一个突出特征。很少有大型系列研究详细描述ARF病例的临床和实验室特征及其结局。我们对1997-2001年所有连续的、血清学确诊的钩端螺旋体病伴ARF病例进行了回顾性分析（n = 58，53例男性，年龄44 ± 13岁，农村居民= 31%，动物接触= 88%）。临床表现（患病率> 50%）：少尿95%，发热和黄疸93%。恶心呕吐83%，出血素质80%，头痛、肝肿大76%，肌痛、腹痛70%，低血压62%，意识障碍50%。多器官功能衰竭（MOF）模式常见：ARF伴肝功能衰竭（72%）、呼吸衰竭（38%）、循环衰竭（33%）、胰腺炎（25%）和横纹肌溶解症（5%）。肾功能不全：35%的病例有肾性K+消耗性缺陷，43%的病例有FENa+ > 1%和低渗透压尿，尽管容量不足。血尿12例，轻度蛋白尿10例。结果：26%死亡，64%在发病后90天肝肾功能正常（但29%维持最初的肾小管缺陷），10%持续性轻度肾衰竭。所有死亡患者除ARF外，至少有两个其他器官衰竭、意识受损和出血素质，而存活者组上述特征的患病率分别为34%、33%和72%（P
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 (n = 58, 53 male, age 44 +/- 13 years, rural residents = 31%, animal contact = 88%.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 K+-wasting defect and 43% a FENa+ > 1% and low-osmolarity urine despite volume depletion. Haematuria was encountered 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 consciousness, and haemorrhagic diathesis vs a prevalence for the above features of only 34, 33, and 72%, respectively, in the survivors group (P