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Leptospirosis AKI Non-Oliguric — ESENeph MCQ

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ModerateAcute Kidney InjuryLeptospirosis AKI Non-OliguricESENeph

A 45-year-old man with leptospirosis develops AKI with jaundice, thrombocytopenia, and conjunctival suffusion. Creatinine rises to 500 umol/L. Urine shows pyuria without organisms. What is the renal pathology?

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Correct answer: B — Acute tubulointerstitial nephritis with direct leptospiral invasion of tubular cells – this is the hallmark renal lesion; AKI is usually non-oliguric and recoverable with appropriate antibiotics

Leptospirosis (Weil disease in severe form) causes AKI through direct leptospiral invasion of proximal tubular cells causing acute tubulointerstitial nephritis. Characteristically, AKI is non-oliguric (unlike most causes of severe AKI) and associated with hypokalaemia (from tubular potassium wasting). Pyuria without bacteriuria is a clue. Treatment with IV Penicillin or Doxycycline is effective. Renal recovery is expected in the majority, though severe cases may require temporary dialysis. The triad of AKI + jaundice + thrombocytopenia in a patient with exposure history (water sports, farming) should trigger leptospiral testing.

Reference: WHO – Leptospirosis; KDIGO 2012 – AKI