Tse Kai-Chung, Yip Pok-Siu, Hui King-Men, Li Fu-Keung, Yuen Kwok-Yung, Lai Kar-Neng, Chan Tak-Mao
Nephrology Division, Department of Medicine, University of Hong Kong.
Clin Diagn Lab Immunol. 2002 Mar;9(2):482-4. doi: 10.1128/cdli.9.2.482-484.2002.
Leptospirosis is a common zoonosis seen worldwide, but it is rare in our locality (Hong Kong). Clinical manifestations of leptospirosis are variable and may range from subclinical infection to fever, jaundice, hemorrhagic tendency, and fulminant hepato-renal failure. Severe hyperbilirubinemia and acute renal failure have been associated with high mortality. We report our experience with a patient who developed severe Weil's syndrome with marked conjugated hyperbilirubinemia and oliguric acute renal failure. These complications persisted despite treatment with penicillin and hemodiafiltration. Plasma exchange was instituted in view of the severe hyperbilirubinemia (970 micromol/liter). This was followed by prompt clinical improvement, with recovery of liver and renal function. The beneficial effects of plasma exchange could be attributed to amelioration of the toxic effects of hyperbilirubinemia on hepatocyte and renal tubular cell function. We conclude that plasma exchange should be considered as an adjunctive therapy for patients with severe icteric leptospirosis complicated by acute renal failure who have not shown rapid clinical response to conventional treatment.
钩端螺旋体病是一种在全球范围内常见的人畜共患病，但在我们当地（香港）较为罕见。钩端螺旋体病的临床表现多样，可从亚临床感染到发热、黄疸、出血倾向以及暴发性肝肾功能衰竭。严重的高胆红素血症和急性肾衰竭与高死亡率相关。我们报告了一名患者的病例，该患者出现了伴有明显结合胆红素血症和少尿性急性肾衰竭的严重韦尔综合征。尽管使用了青霉素和血液透析滤过治疗，但这些并发症仍持续存在。鉴于严重的高胆红素血症（970微摩尔/升），进行了血浆置换。随后患者临床症状迅速改善，肝肾功能恢复。血浆置换的有益效果可归因于高胆红素血症对肝细胞和肾小管细胞功能毒性作用的改善。我们得出结论，对于患有严重黄疸型钩端螺旋体病并伴有急性肾衰竭且对传统治疗未表现出快速临床反应的患者，应考虑将血浆置换作为辅助治疗方法。
