Profile of acute kidney injury in pediatric leptospirosis.

Background/aim: Leptospirosis is an emerging public health zoonotic disease driven by climate and environment. Reports on leptospirosis-induced acute kidney injury (AKI) in children are scant and lacking in detail. The main objective is to provide an accurate and comprehensive description of AKI in pediatric leptospirosis.

Methods: We reviewed records of children ≤ 18 years old referred to the Section of Pediatric Nephrology in a tertiary-level government hospital from January 2004 to December 2012. They presented with clinical manifestations of leptospirosis and a microscopic agglutination test (MAT) ≥ 1:400. Patients were stratified as oliguric and non-oliguric with the former having a urine output of <0.5 mL/kg/h.

Results: A total of 86 cases were included with 53 children (62%) presenting with oliguria during their confinement. Blood urea nitrogen (BUN) (p=0.04) and serum creatinine (p=0.01) levels were significantly more elevated in the oliguric subjects than the non-oliguric children upon hospital admission with a median estimated GFR (eGFR) of 9 and 11 mL/min per 1.73 m(2), respectively. Peritoneal dialysis (PD) was initiated in 19 (36%) patients in the oliguric group. Death occurred in 2 (4%) subjects with oliguric AKI. The most common pathologic serovars isolated were L. manilae (13%) and L. poi (13%).

Conclusion: Anicteric oliguric AKI due to leptospirosis is more frequent and severe than non-oliguric kidney failure in the pediatric population.