Abstract: SA-PO0028
Characteristics and Predictors of AKI in Severe Leptospirosis
Session Information
- AKI: Novel Patient Populations and Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Wijewickrama, Eranga, University of Colombo Faculty of Medicine, Colombo, WP, Sri Lanka
- Priyankara, Dilshan, National Hospital of Sri Lanka, Colombo, WP, Sri Lanka
- Karunanayake, Lilani, Medical Research Institute Sri Lanka, Colombo, WP, Sri Lanka
- Chandraratne, Nadeeka Kumudini, University of Colombo Faculty of Medicine, Colombo, WP, Sri Lanka
- Nethsarani, Nuwani, University of Colombo Faculty of Medicine, Colombo, WP, Sri Lanka
- Singhakumara, Hasini, University of Colombo Faculty of Medicine, Colombo, WP, Sri Lanka
- Mudannayake, Shanya, University of Colombo Faculty of Medicine, Colombo, WP, Sri Lanka
- Kularathne, Dilina, University of Colombo Faculty of Medicine, Colombo, WP, Sri Lanka
- Karunanayake, Panduka, University of Colombo Faculty of Medicine, Colombo, WP, Sri Lanka
Background
Leptospirosis is recognized by the WHO as a neglected tropical disease. Acute kidney injury (AKI) due to leptospirosis in Sri Lanka remains a frequent and a life-threatening complication. This study aimed to identify the clinical and laboratory predictors of AKI in patients with severe leptospirosis.
Methods
A prospective study was conducted over 18 months at the National Hospital of Sri Lanka among adults admitted with severe leptospirosis, as defined by the National Guidelines. Clinical and laboratory parameters were compared between AKI and non-AKI patients, as well as between mild (KDIGO I/II) and severe AKI (KDIGO III) patients. Multivariate analysis was performed using binary logistic regression to examine the predictors of AKI and its severity.
Results
Among 142 patients with severe leptospirosis (mean age 49 years; 73% male), 65.5% developed AKI (31% classified as severe and 34.5% as mild). Of those with AKI, 55% were oliguric, 43% required intensive care unit (ICU) admission, and 25% required dialysis.
Predictors of AKI included oliguria (OR = 6.24, 95% CI [1.86–20.93], p = 0.003), pulmonary involvement; defined as oxygen saturation <94% and/or respiratory rate >30/min (OR = 4.83, 95% CI [1.37–16.95], p = 0.014) and serum potassium (K) < 3.5 mmol/L (OR=4.5, 95% CI [1.48-13.68], p=0.008).
Compared to mild AKI, severe AKI was significantly associated with the presence of jaundice (OR = 20.99, 95% CI: 3.76–117.06, p = 0.001), vomiting (OR = 4.41, 95% CI: 1.19–16.34, p = 0.026), serum potassium > 5.1 mmol/L (OR = 13.75, 95% CI: 2.06–91.76, p = 0.007), and lower platelet count (OR = 0.984, 95% CI: 0.969–0.999, p = 0.041).
Conclusion
AKI was a common complication in severe leptospirosis, with a significant proportion requiring dialysis. Oliguria and pulmonary involvement predicted AKI while jaundice, vomiting and low platelet count were independently associated with severe AKI. Among the patients with severe leptospirosis, a low serum K at presentation predicted the development of AKI. However, among the AKI patients, a high serum K predicted severe AKI, reflecting the changes in the potassium handling by the kidneys during the course of leptospirosis.