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. 1989 Mar;38(1):33-8.

Urinary diagnostic indices in the management of leptospirosis. Selection of patients for dialysis therapy

G D Nicholson, C N Edwards, T A Hassell, C O Everard, J Callender
  • PMID: 2728431

Urinary diagnostic indices in the management of leptospirosis. Selection of patients for dialysis therapy

G D Nicholson et al. West Indian Med J. 1989 Mar.

Erratum in

  • West Indian Med J 1989 Jun;38(2):87

Abstract

Cases of leptospirosis admitted to the Queen Elizabeth Hospital (QEH), Barbados, were assessed for the presence of "pre-renal azotaemia" (NON-ARF) as opposed to "acute renal failure" (ARF). Distinction between the two diagnoses was made on the basis of clinical course. Peritoneal dialysis was inappropriately utilised in 26% of patients receiving such therapy. This study evaluates diagnostic tests for pre-renal azotaemia, and acute renal failure in leptospirosis, and indicates guidelines for the management of azotaemia in such patients. U/P urea and osmolar ratios show high sensitivity and specificity in diagnosing pre-renal azotaemia. While "early" dialysis is essential for patients with acute leptospiral renal failure, in those with plasma creatinines less than 600 mumol/litre on entry and indices indicating NON-ARF, decisions regarding dialysis can safely be delayed for 48-72 hours while the effect of rehydration is assessed.

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