Sitprija Visith, Losuwanrak Kitti, Kanjanabuch Talerngsak
Queen Saovabha Memorial Institute, Bangkok, Thailand.
Semin Nephrol. 2003 Jan;23(1):42-8. doi: 10.1053/snep.2003.50004.
Renal involvement is common in leptospirosis. Clinical manifestations vary from urinary sediment changes to acute renal failure. Renal failure is observed in 44% to 67% of patients. Hypokalemia frequently occurs. Severe hypotension is an important warning sign for the later development of renal and pulmonary complications. Prognosis of the disease is generally good except for its association with pulmonary complications, especially pulmonary hemorrhage and acute respiratory distress syndrome. Interstitial nephritis is the basic renal lesion. Vasculitis is observed in the acute phase of the disease. Tubular necrosis and interstitial nephritis are responsible for renal failure. Glomerular changes usually are not remarkable. Hemodynamic alterations, immune response, and direct nephrotoxicity are responsible for the development of renal lesions. As in many infectious diseases, decreased renal blood flow and glomerular filtration rate play a basic role. Bacterial invasion and toxicity of outer membrane with generation of cytokines, chemokines, and cellular infiltration are important in cellular injury.
钩端螺旋体病常累及肾脏。临床表现从尿沉渣改变到急性肾衰竭不等。44%至67%的患者会出现肾衰竭。低钾血症频繁发生。严重低血压是肾脏和肺部并发症后期发展的重要警示信号。除了与肺部并发症相关，尤其是肺出血和急性呼吸窘迫综合征外，该病的预后总体良好。间质性肾炎是基本的肾脏病变。在疾病急性期可观察到血管炎。肾小管坏死和间质性肾炎是肾衰竭的原因。肾小球改变通常不显著。血流动力学改变、免疫反应和直接肾毒性是肾脏病变发生的原因。与许多传染病一样，肾血流量和肾小球滤过率降低起基本作用。细菌入侵、外膜毒性以及细胞因子、趋化因子的产生和细胞浸润在细胞损伤中起重要作用。
