Monday, November 16, 2009

Leptospirosis-induced Renal Failure

T-Minus 2 days to the Nephrology Boards exams! For any of you out there studying, one useful resource is ASN's "NephSAP Core Knowledge Questions", which can be easily reached via the ASN web page. Unlike the main NephSAP questions which tend to ask for very specific details about the content of the NephSAP text (which often involves specific articles or newfangled molecular mechanisms which are unlikely to be tested in the Boards), the Core Knowledge Questions are more general and therefore more Boards-relevant.

Today's topic is leptospirosis, a zoonotic infection caused by the spirochete Leptospira interrogans. Leptospirosis is spread via exposure to contaminated tissue from a variety of mammalian hosts, often rodents (but can also include cattle, pigs, goats, horses, even dogs). While leptospirosis is most commonly found in tropical areas, it nonetheless has a worldwide distribution and can certainly be found within the United States, as evidenced by this outbreak of participants in an Illinois triathlon, who were presumably exposed while swimming in lakewater.
Up to 10% of individuals with leptospirosis will develop acute kidney injury. The mechanism of AKI is still under debate. Some have suggested that Leptospira endotoxin simply results in an inflammatory response, much like gram-negative LPS; usually, AKI occurs in the setting of multi-organ failure and critical illness. Others have suggested that Leptospira endotoxin has tubular toxicity, as evidenced by a high frequency of renal potassium-wasting and hypokalemia noted in these patients. Still others have stated that tubulointerstitial nephritis is the main mechanism of kidney injury in Leptospirosis. In some instances, rhabdomyolysis can be the main cause of Leptospirosis-associated AKI.
Treatment of Leptospirosis-associated AKI includes standard supportive measures, along with the use of antibiotics (either penicillins or tetracyclines are typically used).

2 comments:

Anonymous said...

I think the importnat consideration with Leptospirosis is to look at the immunopatholgoy caused byt the antigen itself with the immune system. Leptospirosis vaccination has lead to reanl failure in dogs within 48 hours in some cases and like Lyme vaccine we see the same manifestations of the disease patholgoy if you get the disease or get the vaccine! WHOOOPPPSS looks like yet another unforeseen problem with advising vaccines as some kind of golden chalice of disease prevention. NOT!
Ever wonder why they do not have Leptospirosis vaccines for humans, the VACCINE REACTION MAN! I have seen tumors arise within several days of administering a Leptospirosis mumbo jumbo vaccine administered to dogs, I have seen the worse puritis and reaction, inflamatory reactions that last 4 years to the nonexistent immunity they claim for the Lepto vaccine. Vaccines often time confer the same patholgoy of the very infection due to the immunopathology it produces in the vaccinate. Also, this fact, vaccination of the dog DOES NOT prevent infection with Lepto, nor renal tubule colonization. So, go ahead give bad advice and see when this vaccination of the dogs will actually lead to a false sense of security enabling a less informed human to get Lepto form his subcliniccaly infected dog.....you better recognize the diseae in humans, by promoting vaccination of the dogs you are increasing the chanse that you will indeed miss this in one of your patients.

Darren said...

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