Legionnaires' disease with acute renal failure

Area of Science:

• Nephrology
• Infectious Diseases

Background:

• Legionnaires' disease (LD) is a severe pneumonia with potential extrapulmonary manifestations.
• Acute renal failure (ARF) is a recognized complication of LD, but its pathogenesis remains unclear.

Observation:

• This report details two cases of ARF in patients with LD.
• Neither patient presented with hypotension or received nephrotoxic antibiotics, suggesting LD itself as a direct cause of renal injury.
• The first patient experienced a severe, fatal course despite maximal supportive care, including peritoneal dialysis.
• The second patient recovered following erythromycin treatment and hemodialysis.

Findings:

• Renal pathology in the first patient was consistent with acute tubular necrosis (ATN).
• The clinical course in both patients supported ATN as the likely diagnosis.
• These cases highlight the potential severity of renal involvement in LD.

Implications:

• The findings suggest a direct pathogenic role for Legionella bacteria in causing ATN.
• Further research is needed to elucidate the specific mechanisms underlying ARF in LD.
• Understanding these mechanisms could lead to targeted therapies for preventing or treating kidney injury in LD patients.