Daher Elizabeth De Francesco, de Abreu Krasnalhia Lívia Soares, da Silva Junior Geraldo Bezerra
Discipline of Nephrology of the Medical School of the Federal University of Ceará.
J Bras Nefrol. 2010 Dec;32(4):400-7.
Leptospirosis is the most important zoonosis in the world. Patients are typically young men. Several factors are involved in acute kidney injury (AKI) in leptospirosis, including direct nephrotoxic action of the leptospira, hyperbilirubinemia, rhabdomyolysis and hypovolemia. The major histological findings are acute interstitial nephritis and acute tubular necrosis. Leptospirosis-induced AKI is usually nonoliguric and hypokalemic. Tubular function abnormalities precede a decline in the glomerular filtration rate, which could explain the high frequency of hypokalemia. Antibiotic treatment is efficient in the early and late and/or severe phases. For critically ill leptospirosis patients, the following measures are recommended: early and daily hemodialysis; low volume infusion (due to the risk of pulmonary hemorrhage); and lung-protective strategies. Mortality in leptospirosis-associated AKI is around 22%.
钩端螺旋体病是世界上最重要的人畜共患病。患者通常为年轻男性。钩端螺旋体病急性肾损伤（AKI）涉及多个因素，包括钩端螺旋体的直接肾毒性作用、高胆红素血症、横纹肌溶解和血容量不足。主要组织学表现为急性间质性肾炎和急性肾小管坏死。钩端螺旋体病所致AKI通常为非少尿型且低钾血症。肾小管功能异常先于肾小球滤过率下降，这可以解释低钾血症的高发生率。抗生素治疗在早期、晚期和/或重症阶段均有效。对于重症钩端螺旋体病患者，建议采取以下措施：早期每日进行血液透析；小剂量输液（因有肺出血风险）；以及肺保护策略。钩端螺旋体病相关AKI的死亡率约为22%。
