Acute renal failure in leptospirosis in Uruguay

Abstract

The present study was carried out to describe epidemiology and clinical pattern of acute renal failure caused by leptospirosis in Uruguay. For these purposes, all literature published in Uruguay was reviewed. Three studies were analyzed: 2 series of patients and 1 case report that summarize 26 cases. The incidence of acute renal failure found in the first study was 8% and in the second one, 15%. The first study included only dialyzed patients, which could explain the aforementioned difference. The estimated annual incidence of leptospirosis in Uruguay is about 10 cases/year. Therefore, the expected incidence of acute renal failure due to leptospirosis is of 0.7-1.3 cases/year. All but 1 case were males. Mean age was 35 +/- 14.5. Source of infection was known in 23/26. Typical symptoms were: fever 26/26, myalgias 22/26, dehydration 21/26, jaundice 21/26, conjunctival suffusion 20/26, and digestive disturbance 18/26. Bleeding and meningitis were infrequent (8/26, 5/26, respectively). Acute renal failure was intrinsic in 18/26. Nonoliguric forms were predominant (14/18). Kalemia was low or normal in 22/26 cases. Dialysis was performed in 9/26 cases, but the number of dialyses per patient was high (9.4 +/- 4). The survival rate was 23/26. We concluded that leptospirosis is an infrequent cause of acute renal failure in Uruguay, with an expected frequency of approximately 1 case/year. Clinical picture was typical and contact was frequently known, which made diagnosis easy. Acute renal failure was predominantly polyuric and with low or normal kalemia; survival rate was high.