[Leptospiroses with acute renal failure--report on 6 dialyzed patients]

From 1968 to 1981 6 patients with severe leptospiroses were treated: one with leptospirosis icterohaemorrhagiae (Weil's disease), two with leptospirosis copenhageni and three with leptospirosis grippotyphosa. The diagnosis must at first clinically be made from exposition anamnesis and symptoms. In three patients the agglutination lysis reaction had a negative result still between the 10th and 19th day after the beginning of the disease. In all 6 cases a hypercatabolic acute renal failure with azothaemia of high degree was present. The polyuric phase developed 10 to 18 days after the beginning of the disease, the serum creatinine values normalized 20 to 35 days after the beginning of the disease. The parenteral nutrition and the dialysis therapy were particular points in the complex therapy of the patients. 4 patients were haemodialysed - 3 of them after primary peritoneal dialysis - 2 patients were only peritoneally dialysed. On account of the hypercatabolism and the intestinal paralysis the haemodialysis is to be preferred, as a rule, to the peritoneal dialysis. Also in the haemodialysis of patients with leptospirosis modern developments should be taken into consideration: bicarbonate-containing dialytic solution and in haemorrhagic diathesis the heparin-free dialysis. All 6 own patients survived. When connecting these data with other reports from Central and South Europe the lethality of dialysed cases with leptospirosis is about 42% (25 of the 59 patients died). In 4 of 5 of our patients with leptospirosis a clear hyperamylasaemia was present, apparently the expression of the involvement of the pancreas.