Focus into the role of acute kidney injury in leptospirosis: an observational hospital based study in north eastern India

Background: Leptospirosis is an emerging public health zoonotic disease affecting humans and animals alike. In humans, it can lead to a wide range of presentations, some of which may be mistaken for other diseases commonly occurring in the community. Without treatment, Leptospirosis can be fatal leading to kidney damage, meningitis, liver failure, respiratory distress, and even death. Reports on leptospirosis-induced acute kidney injury (AKI) in this part of country are scant and lacking in detail. Materials and Methods: A total of 56 patients above the age of 12 with a seropositive leptospira test admitted in Silchar Medical College and Hospital from 1st June 2016 to 31st December 2017 were included in the present study. AKI was defined according to the KDIGO definition. Patients were stratified as oliguric and non-oliguric with the former having a urine output of 0.5 mL/kg/hr. Results and Observations: Out of 56 patients that fit into our inclusion criteria, 31 (55.35%) of them had developed acute kidney injury. Other than fever, symptoms on presentation included headache 41 (73.21%), myalgia 36(64.28%) and jaundice 35 (62.5%) respectively. Blood urea nitrogen (BUN) and serum creatinine levels were significantly elevated in the oliguric subjects than the non-oliguric patients. Adverse outcome with respect to renal replacement therapy requirement and death were more common in oliguric patients. Conclusion: The majority of patients who developed AKI following leptospirosis required renal replacement therapy. Non-oliguric forms had better prognosis and oliguria and hyperkalemia have been identified as predictors of a poor outcome.