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Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis?
R Martinelli1, M A Luna, H Rocha
1Departamento de Medicina-Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brasil.
Abstract:
Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120 micrograms/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.
Insights
This study investigated rhabdomyolysis in leptospirosis patients. While elevated myoglobin was common, a direct link to acute kidney injury or disease severity was not found.
Area of Science:
- Nephrology
- Infectious Diseases
- Toxicology
Background:
- Leptospirosis is a significant cause of acute renal failure.
- The specific role of rhabdomyolysis in leptospirosis-associated kidney injury requires further analysis.
Purpose of the Study:
- To investigate the occurrence and potential role of rhabdomyolysis in patients with leptospirosis.
- To explore the relationship between markers of muscle damage and the severity of acute kidney injury in leptospirosis.
Main Methods:
- Prospective study of 16 consecutively admitted leptospirosis patients.
- Clinical assessment including jaundice, conjunctival suffusion, and myalgias.
- Laboratory tests: urinalysis, urea, creatinine, aminotransferases, creatine phosphokinase (CPK), and serum myoglobin.
Main Results:
- All patients presented with sudden onset; jaundice, conjunctival suffusion, and myalgias were common.
- Renal impairment (elevated urea and creatinine) was observed in 87.5% and 74.0% of patients, respectively.
- Elevated aminotransferases, CPK, and serum myoglobin (≥120 µg/L in 56.2%) were frequent, but no correlation with renal failure or disease severity was established.
Conclusions:
- Rhabdomyolysis markers, including elevated myoglobin, are common in leptospirosis.
- Despite frequent occurrence, a direct correlation between myoglobin levels and acute kidney injury or disease severity in leptospirosis could not be demonstrated in this cohort.