Top

Journal of Medical Case Reports

Published in:

Open Access 01-12-2021 | Kidney Injury | Case report

Acute kidney injury with partial Fanconi syndrome in a patient with leptospirosis: a case report

Authors: Marc Weiner, Matteo Coen, Jacques Serratrice, Thomas A. Mavrakanas, Antonio Leidi

Published in: Journal of Medical Case Reports | Issue 1/2021

Abstract

Background

Leptospirosis is an underdiagnosed bacterial infection with nonspecific symptoms, hence, a diagnostic challenge. Identifying a case of leptospirosis in Switzerland is uncommon. Although kidney complications are frequent in severe forms, including tubular dysfunction, observing this complication is rare in our country. We report the case of a patient with leptospirosis and kidney dysfunction, which was notable for proximal tubulopathy. This case report describes the diagnosis and management of this patient’s tubular dysfunction.

Case presentation

A 34-year-old Caucasian male known for alcohol and drug abuse presented to our emergency department suffering from severe pain in the lower limbs, jaundice, and fever with flu-like symptoms. Physical examination was not contributory. Blood tests showed cytopenia, elevated inflammatory markers, acute kidney injury, and altered liver function tests with predominant cholestasis. Urinalysis showed proteinuria and significant glycosuria without concomitant hyperglycemia. Leptospirosis was suspected and confirmed by both positive serum polymerase chain reaction and elevated immunoglobulin M for Leptospira interrogans. The patient was treated with intravenous amoxicillin–clavulanate and doxycycline for 7 days. After antibiotic treatment, symptoms disappeared, and kidney dysfunction completely resolved.

Conclusion

Our case focuses on the description of leptospirosis-related acute kidney injury with proximal tubular dysfunction, which is a rare finding in Switzerland.

Lane AB, Dore MM. Leptospirosis: a clinical review of evidence based diagnosis, treatment and prevention. World J Clin Infect Dis. 2016;6:61–6. https://doi.org/10.5495/wjcid.v6.i4.61.CrossRef

Johnson RC, Faine S. Leptospira. In: Bergey’s manual of systematic bacteriology, vol. 1. 1984:62–7.

Schreiber PW, Aceto L, Korach R, et al. Cluster of leptospirosis acquired through river surfing in Switzerland. Open Forum Infect Dis. 2015;2:ofv102. https://doi.org/10.1093/ofid/ofv102.CrossRefPubMedPubMedCentral

Giulieri S, Tissot F. A short journey through spirochetal infections. Rev Med Suisse. 2010;6:721–6.PubMed

Federal Food Safety and Veterinary Office. La leptospirose chez l'homme et chez l'animal. 2017. https://www.blv.admin.ch/blv/fr/home/tiere/tierseuchen/uebersicht-seuchen/alle-tierseuchen/leptospirose.html. Accessed 14 Sept 2020.

Levett PN. Leptospirosis. Clin Microbiol Rev. 2001;14:296–326. https://doi.org/10.1128/CMR.14.2.296-326.2001.CrossRefPubMedPubMedCentral

Cetin BD, Harmankaya O, Hasman H, et al. Acute renal failure: a common manifestation of leptospirosis. Ren Fail. 2004;26:655–61. https://doi.org/10.1081/jdi-200037154.CrossRefPubMed

Khositseth S, Sudjaritjan N, Tananchai P, et al. Renal magnesium wasting and tubular dysfunction in leptospirosis. Nephrol Dial Transplant. 2008;23:952–8. https://doi.org/10.1093/ndt/gfm698.CrossRefPubMed

Picardeau M. Virulence of the zoonotic agent of leptospirosis: still terra incognita? Nat Rev Microbiol. 2017;15:297–307. https://doi.org/10.1038/nrmicro.2017.5.CrossRefPubMed

10.

Izzedine H, Launay-Vacher V, Isnard-Bagnis C, et al. Drug-induced Fanconi’s syndrome. Am J Kidney Dis. 2003;41:292–309. https://doi.org/10.1053/ajkd.2003.50037.CrossRefPubMed

11.

Liamis G, Rizos E, Elisaf MS. Reversible proximal tubular dysfunction in a patient with acute febrile illness and normal renal function: an evidence towards leptospirosis. Clin Nephrol. 2000;53:316.PubMed

12.

Liberopoulos E, Bairaktari E, Elisaf M. Reversible proximal tubular dysfunction in a patient with acute febrile illness, marked hyperbilirubinemia and normal renal function: evidence of leptospirosis. Nephron. 2002;91:532–3. https://doi.org/10.1159/000064304.CrossRefPubMed

13.

Yang CW, Pan MJ, Wu MS, et al. Leptospirosis: an ignored cause of acute renal failure in Taiwan. Am J Kidney Dis. 1997;30:840–5. https://doi.org/10.1016/s0272-6386(97)90091-3.CrossRefPubMed

14.

Krishnan A, Karnad DR, Medhekar TP. Paralysis due to renal potassium wasting: an unusual presentation of leptospirosis. Nephrol Dial Transplant. 2003;18:2454–5. https://doi.org/10.1093/ndt/gfg350.CrossRefPubMed

15.

Yamaguchi T, Higa N, Okura N, et al. Characterizing interactions of Leptospira interrogans with proximal renal tubule epithelial cells. BMC Microbiol. 2018;18:64. https://doi.org/10.1186/s12866-018-1206-8.CrossRefPubMedPubMedCentral

16.

Wu MS, Yang CW, Pan MJ, et al. Reduced renal Na+-K+-Cl- co-transporter activity and inhibited NKCC2 mRNA expression by Leptospira shermani: from bed-side to bench. Nephrol Dial Transplant. 2004;19:2472–9. https://doi.org/10.1093/ndt/gfh452.CrossRefPubMed

17.

Spichler A, Ko AI, Silva EF, et al. Reversal of renal tubule transporter downregulation during severe leptospirosis with antimicrobial therapy. Am J Trop Med Hyg. 2007;77:1111–9.CrossRefPubMed

18.

Yang CW. Leptospirosis renal disease: understanding the initiation by Toll-like receptors. Kidney Int. 2007;72:918–25. https://doi.org/10.1038/sj.ki.5002393.CrossRefPubMed

19.

Yang CW, Wu MS, Pan MJ, et al. Leptospira outer membrane protein activates NF-kappaB and downstream genes expressed in medullary thick ascending limb cells. J Am Soc Nephrol. 2000;11:2017–26.CrossRefPubMed

20.

Werion A, Lengele JP. Fanconi syndrome in alcoholic patients: old concept new idea. Nephron. 2019;141:201–2. https://doi.org/10.1159/000496035.CrossRefPubMed

Title: Acute kidney injury with partial Fanconi syndrome in a patient with leptospirosis: a case report
Authors: Marc Weiner
Matteo Coen
Jacques Serratrice
Thomas A. Mavrakanas
Antonio Leidi
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Kidney Injury
Leptospirosis
Acute Kidney Injury
Leptospira
Antibiotic
Acute Kidney Injury
Hypokalemia
Published in: Journal of Medical Case Reports / Issue 1/2021
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-021-02978-0

At a glance: The STEP trials

Springer Medicine

Acute kidney injury with partial Fanconi syndrome in a patient with leptospirosis: a case report

Abstract

Background

Case presentation

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Bilateral pelvic kidneys with upper pole fusion and malrotation: a case report and review of the literature

Primary ectopic axillary breast cancer: a case series

Superficial siderosis as a rare cause of visual and auditory pseudohallucinations: a case report

Autoimmune pulmonary alveolar proteinosis successfully treated with lung lavage in an adolescent patient: a case report

Dual treatment of acromegaly and hormone-receptor-positive breast cancer with tamoxifen: a case report

Atypical idiopathic intracranial hypertension presenting as cyclic vomiting syndrome: a case report