Abstract: SA-PO0029
From Exposure to Organ Failure: A Severe Case of 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
- Sakhuja, Priyal, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Rohatgi, Rajeev, James J Peters VA Medical Center, New York, New York, United States
Introduction
Leptospirosis is an endemic bacterial infection found in tropical climates but also observed in temperate climates and associated with exposure to animals, specifically, rodent urine. We describe a case of leptospirosis which presents with acute kidney injury (AKI), hyperosmolar hyperglycemia, hyperbilirubinemia, and mild transaminitis.
Case Description
A 49-year-old-male with type II diabetes, hypertension, and NASH presented with myalgias and two days of non-bloody emesis. Upon arrival, the patient was tachycardic, normotensive, with low-grade fevers and 15 lbs weight loss over 2 weeks. Serum glucose was 853 mg/dL, serum creatinine (sCr) 5.5 mg/dL (baseline ~1.1 mg/dL), serum Na 122 meq/L, total bilirubin (Tbil) 10 mg/dL, direct bilirubin (Dbil) 7 mg/dL and urinalysis with glucose, blood, trace ketones and protein. The anion gap was 25 with a lactate 5.3 mmol/L, but no serum ketones. The patient was admitted to the ICU and nephrology was consulted for presumptive pre-renal AKI due to hyperosmolar hyperglycemia state (HHS). However, sCr rose to 6.4 mg/dL despite volume resuscitation and insulin. The worsening sCr was accompanied by hypokalemia, hypomagnesemia and hypophosphatemia despite aggressive electrolyte repletion. Tbil and Dbil worsened even though hepatic workup was unremarkable. Liver biopsy showed mild steatosis. The patient reported exposure to rodent urine as a sanitation worker, so doxycycline (doxy) was empirically started and Leptospira IgM was ordered which was positive. Kidney and liver function improved after starting doxy therapy.
Discussion
Although uncommon in NYC (24 cases in 2023), leptospirosis is an important differential diagnosis for patients with AKI, electrolyte abnormalities, hyperglycemia and hyperbilirubinemia. Renal involvement is characterized by tubulointerstitial nephritis and proximal tubule dysfunction, similar to Fanconi’s syndrome. Hypokalemia, hypomagnesemia, and normo-to-hypo phosphatemia are unusual findings in subjects with severe AKI but can overlap with HHS. Bilirubinemia was an important clue in the differential diagnosis since this is not commonly observed in AKI or HHS. Moreover, non-oliguric AKI, despite evidence of volume depletion, implies predominantly tubular dysfunction rather than pre-renal azotemia or glomerular disease. In our patient, early recognition and prompt management prevented the need for dialysis and long-term kidney dysfunction.