Leptospiral Nephropathy

Leptospiral Nephropathy 3 27 89 9 14 38.8 80/50 102 28 17400/cmm 8.3 gm/dl 24000/cmm 72 mg/dl 6.8 mg/dl (SGPT) 80 u/l 9.1 mg/dl CPK 15400 u/l X ( 1) ( 2) ( 3) 2 leptospira shermani ( 4) 1 2 93 16 3 179

(leptospirosis) Weil s Syndrome 3 4 Leptospira shermani 40 leptospirosis (re- emerging infectious disease) [5-11] 1976 20 1997 Scr 10.8 mg/dl Scr 2.4 mg/dl 2 leptospirosis [12] 2000 9 Leptospirosis Adolf L.shermani Weil 1886 leptospirosis leptospirosis leptospirosis [1] 1915 Inada Ido 6 20 leptospirosis um 0.1 um 12 18 L.interrogans [2] C S 250 (serovars) 200 serovars [3] Leptospirosis [13] Leptospirosis 2 20 90% 5 [4] 1990 10% Weil s Syndrome 180 93 16 3

5 30% [14] leptospirosis 4. (hypokalemia) leptospirosis [12,13,15-18] Na-transporter [24,25] (hyperkalemia) (leptospiral nephropathy) leptospiral nephropathy 1. casts 1. myoglobinuria hemoglobinuria bile pigmented casts thalassemia glucose -6 phosphate dehydrogenase deficiency [13] 2. 4 [13] [18,19] 3. IgM (interstitial nephritis) C3 [18] (tubular necrosis) 4. (vasculitis) 2. (Acute Renal Failure; ARF) leptospirosis 20 67% ARF sero- C3 [30] var ARF [18] (thrombocytopenia) 5. Leptospirosis ARF (tumor necrosis factor; TNF) ARF [20,21] (a)leptospires (hemolytic uremic [23] leptospires lipopolysaccharides (LPSs) outer membrane proteins [3,26-29] leptospires LPSs [18] 5 [31] (b) syndrome; HUS) ARF [22] (c) ARF Leptospirosis ARF 1. Aqua penicillin 1.5 3 MU 6 7 3. Leptospirosis Jarisch-Herxheimer 93 16 3 181

5 Leptospirosis ( 34) [32] Doxycycline Amoxicillin Ampicillin Cephalosporins Ceftriaxone Cefotaxime Quinolone [33] 2. [34] 1. leptospirosis 5 30% [14,18] 2. Leptospirosis 3. Leptospiral nephropathy leptospiral nephropathy 1. Weil A: Ueber eine eigentumliche, mit Milztumor, Icterus und Nephritis einhergehende acute infektino skionskrankheit. Dtsche. Arch Klin Med 1886; 39: 209-32. 2. Inada R, Ido Y: A report on the discovery of the causative organism (a new species of Spirochaeta) of Weil s disease (in Japanese). Tokyo Ijishinshi (Tokyo Med J) 1915; 1908: 351-60. 3. Joseph M, Vinetz: Leptospirosis. Curr Opin Infect Dis 2001; 14: 527-38. 4. Alan RK, Veron EA, Paul VE, et al: Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. Clinical Infection Disease 2001; 33: 1834-41. 5. CDC. Update: Leptospirosis and unexplained acute febrile illness among athletes participating in triathlons Illinois and Wisconsin, 1998. JAMA 1998; 280: 1474-5. 6. Rosalie TT, Jose GR, David AA, et al: Epidemic leptospirosis associated with pulmonary hemorrhage-nicaragua, 1995. The Journal of Infectious Disease 1998; 178: 1457-63. 7. CDC. Outbreak of acute renal febrile illness among athletes participating in triathlons Illinois and Wisconsin, 1998. MMWR 1998; 47: 585-8. 8. Eduard JS, Jose GR, Henk LS, et al: Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1996. Am J Trop Med Hyg 1999; 61: 399-404. 9. Shah I, Warke S, Deshmukh CT, et al: Leptospirosis-an underdiagnosed clinical condition. J Postgrade Med 1999; 45(3): 93-4. 10. CDC. Update: Outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000-Borneo, Malaysia, 2000. Annals of Emergency Medicine 2001; 38(1): 83-4. 182 93 16 3

11. Alan RK, Vernon EA, Paul VE, et al: Leptospirosis in Hawaii, 1974-1998: epidemiologic analysis of 353 laboratory confirmed cases. Am J Trop Med Hyg 2002; 66(1): 61-70. 12. Yang CW, Pan MJ, Wu MS, et al.: Leptospirosis: an ignored cause of acute renal failure in Taiwan. AJKD 1997; 30(6): 840-5. 13. Sitprija V, Dennis VM, Ferris TF, et al: Renal involvement in leptospirosis, in Robinson RR Nephrology (Vol. 2). New York, Springer-Verlag, 1984, pp 1041-52. 14. Herve D, Deborah DP, Jean LP, et al: Leptospirosis: prognostic factors associated with mortality. Clinical Infectious Disease 1997; 25: 720-4. 15. Ramon P: Acute renal failure in severe leptospirosis. Nephrol Dial Transplant 2003; 18: 1235-6. 16. Gerke P, Rump LC: Leptospirosis 3 cases and a review. Clinical Nephrology 2003; 60(1): 42-8. 17. Yang CW, Wu MS, Pan MJ: Leptospirosis renal disease. Nephrol Dial Transplant 2001; 16(suppl. 5): 73-7. 18. Adrian C, David JA, Paul GT, et al: A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature. Nephrol Dial Transplant 2003; 18: 1128-34. 19. Vijitr B, Virawudh S: Pathology of renal disease in the Tropics. Seminar in Nephrology 2003; 23(1): 88-106. 20. Niwattayakul K, Homvijitkul J. Khow O, et al: Leptospirosis in northeastern Thailand: hypotension and complications. Public Health 2002; 33: 155-60. 21. Tajiki MH, Salomao R: Association of plasma levels of tumor necrosis factor α with severity of disease and mortality among patients with leptospirosis. Clinical Infectious Disease 1996; 23: 1177-8. 22. Hanvanich M, Moollaor P, Suwangool P, et al: Hemolytic uremic syndrome in leptospirosis bataviae. Nephron 1985; 40: 230-1. 23. Barsoum R, Sitprija V: Tropical nephropathy, in Schrier RW (ed.): Disease of the Kidney and Urinary Tract. Lippincott Williams & Wilkins, 2001, pp.2301-49. 24. Lin CL, Wu MS, Yang CW, et al: Leptospirosis associated with hypokalemia and thick ascending limb dysfunction. Nephrol Dial Transplant 1999; 14: 193-5. 25. Abdulkader RC, Seguro Ac, Malheiro, et al.: Peculiar electrolytic and hormonal abnormalities in acute renal failure due to leptospirosis. Am J Trop Med Hyg 1996; 54: 1-6. 26. Yang CW, Wu MS, Pan MJ, et al.: Leptospira outer membrane protein activates NF-kB and downstream gene expressed in medullary thick ascending limb cells. J Am Soc Nephrol 2000; 11: 2017-26. 27. Yang CW, Wu MS, Pan MJ, et al.:the leptospira outer membrane protein LipL32 induces tubulointerstitial nephritis-mediated gene expression in mouse proximal tubule cells. J Am Soc Nephrol 2002; 13: 2037-45. 28. Barnett JK, Barnett D, Bolin CA, et al: Expression and distribution of leptospiral outer membrane components during renal infection of hamsters. Infet Immun 1999; 67: 853-61. 29. Paul AC, David AH, Dieter MB, et al: Lip21 is a novel surfaceexposed lipoprotein of pathogenic Leptospira species. Infection and Immunity 2003; 71(5): 2414-21. 30. Sitprija V, Pipatanagul V, Mertowidjojo K, et al: Pathogenesis of renal disease in leptospirosis. Kidney Int 1980; 17: 827-36. 31. Visith S, Kitti L, Talerngsak K: Leptospiral Nephropathy. Seminar in Nephrology. 2003; 23(1): 42-8. 32. Paul NL: Leptospirosis. Clinical Microbiology Review 2003; 14:296-326. 33. Thanachai P, Somnuek D, Asda V, et al: Ceftriaxone compared with sodium penicillin G for treatment of severe leptospirosis. Clinical Infectious Diseases 2003; 36: 1507-13. 34. Sitprija V: Tropical diseases and therapeutic intervention. Proceedings of International Congress of Dialysis and Apheresis for the New Millennium, Chiang Mai, Thailand, November 9-10, 2000, p 95 (abstr). Leptospirosis 92 5 >=100X >=400X 1. 2. (1) (2) (3) 93 16 3 183