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Kidney Week

Abstract: PO0106

Weil Disease Causing Kidney Failure Responsive to Steroids

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Androga, Lagu A., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
Introduction

Weil’s disease is a life-threatening form of leptospirosis with a potential mortality >22%. Multi-organ dysfunction, acute interstitial nephritis (AIN) and/or acute tubular necrosis (ATN) can occur. We present a patient with Weil’s disease who developed acute kidney injury requiring hemodialysis. Treatment with steroids resulted in return to baseline renal function.

Case Description

A 61 year old Caucasian male presented with fevers, lower extremity myalgias, non-bloody emesis, and abdominal pain that began 11 days after swimming in Jamaica. On admission, he was febrile, tachycardic but normotensive with jaundice and leg edema. Admission labs revealed BUN 37, serum creatinine (SCr) 3.3mg/dL (baseline SCr 1), Hemoglobin 14.6g/dL, platelets 25,000, CRP 171.5mg/dL, ESR 41mm/h, serum albumin 3g/dL, AST 153, ALT 75, and direct bilirubin 7.8mg/dL. Urinalysis showed proteinuria 545mg/dL, sterile pyuria of 4-10 WBC, and positive hemoglobin. Creatinine kinase was 5143. Given his history and presentation, leptospira IgM testing was performed and found to be positive. He received supportive therapy and a 10 day course of IV ceftriaxone.
His kidney function deteriorated with SCr peak of 8.22mg/L on day 4 (Figure 1). Given anuria and fluid overload, hemodialysis was started. A kidney biopsy was contemplated to assess for AIN, podocytopathy, pigment nephropathy, ATN or a combination, but contraindicated due to thrombocytopenia. Empiric treatment with steroids was started on day 4 (Figure 1) with 250mg IV Solumedrol for 3 days, followed by 40mg daily of oral prednisone tapered by 10mg every 2 weeks over 8 weeks. Urine output improved gradually on day 6 and day 7 to 1.5 and 5.7 L/day, respectively. SCr also started to decrease. At 2 months post hospital discharge, SCr was 1mg/dL on 4mg of prednisone.

Discussion

Renal failure in Weil’s disease can be severe, requiring dialysis. Treatment with steroids for presumed AIN can be beneficial when initiated early.