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NEFROTİK SENDROM, AKUT BÖBREK YETERSİZLİĞİ VE TROMBOSİTOPENİ İLE PREZENTE OLAN BİR LEPTOSPİROZ OLGUSU

ACASE OF LEPTOSPIROSIS PRESENTING WITH NEPHROTIC SYNDROME, ACUTE RENAL FAILURE AND THROMBOCYTOPENIA

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2009

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Leptospirosis is a disease caused by the spirochete of the group Leptospirae. Its clinical presentations are mostly subtle. We present a case of leptospirosis presenting with nephrotic syndrome, acute renal failure (ARF) and thrombocytopenia. A 50-year-old male patient was admitted for abdominal pain and swelling. He had painful fingers, elbows, knees and the fever five days ago. However, arthralgia and fever regressed with ampicillin treatment. On the admission physical examination, edema, hypotension, bilateral pleural effusion and ascites were present. The characteristics of the ascit es was compatible with the nephrotic syndrome. Abnormal laboratory findings were; thrombocyte: 35000/mm3, proteinuria: 9 g/day, serum albumin: 2.4 g/dL, CPK: 1526 U/L, AST: 134 U/L, ALT: 58 U/L. Abundant dismorfic erythrocytes were seen in urinary sediment. The next day thrombocyte count was 24000 mm3. Urine output gradually decreased and creatinine level increased to 6.2 mg/dl on the 4th day. Hepatitis markers were negative. No fever or jaundice was seen during the follow-up. Leptospirosis was considered due to mildly increased levels of AST, ALT, high CPK, thrombocytopenia and nephrotic syndrome complicated with acute renal failure. A treatment including 2x100 mg/day doxycycline and 1x2 g/day ceftriaxone was started. Urine output increased to 6 L/day on the 3rd day of treatment. Thrombocyte, CPK, and serum creatinine levels returned to normal on 3rd, 5th and 6th days of the treatment, respectively. Proteinuria gradually decreased and totally disappeared on the 15th day. Antimicrobial therapy was continued for 20 days. Meanwhile a very high titer of leptospira IgM and a mild increase in the titer of leptospira IgG was observed in the ELISA test for leptospira antibodies. In conclusion, while the principal lesion of leptospiral nephropathy is tubulointerstitial nephritis, it may rarely present as nephrotic syndrome complicated with acute renal failure. Hypotension, thrombocytopenia, and elevated CPK were the pointers for the correct diagnosis. Nephrotic syndrome and ARF improved with the appropriate antimicrobial therapy without need for dialysis
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Abstract (Original Language): 
Leptospiroz bir spiroket ile meydana gelir. Klinik tablolar› ço¤unlukla subkliniktir. Burada nefrotik sendrom, akut böbrek yetersizli¤i (ABY) ve trombositopeni ile prezente olan bir leptospiroz olgusu sunulacakt›r. Elli yafl›ndaki erkek hasta kar›nda a¤r› ve flifllik flikayeti ile baflvurdu. Befl gün önce her iki el parmaklar›, dirsekler ve dizlerde a¤r› ve atefl yak›nmas› olmufl. Ancak, artralji ve atefl ampisilin ile gerilemifl. Geldi¤inde, ödem, hipotansiyon, bilateral effüzyon ve asit saptand›. Asit nefrotik sendromla uyumlu bulundu. Çeflitli laboratuar bulgular›; trombosit: 35000/mm3, proteinüri: 9 gr/gün, serum albumin: 2,4 g/dL, CPK: 1526 U/L, AST: 134 U/L, ALT: 58 U/L. ‹drar sedimentinde bol dismorfik eritrosit görüldü. Ertesi gün trombosit say›s› 24000/mm3 oldu. ‹drar miktar› giderek azald› ve 4. günde kreatinin düzeyi 6,2 mg/dL oldu. Hepatit belirteçleri negatifti. ‹zlemi boyunca atefl ve sar› l›k görülmedi. Orta derecede AST, ALT yüksekli¤i, yüksek CPK, trombositopeni ve ABY ile komplike olan nefrotik sendrom olmas› nedeniyle leptospiroz düflünüldü. Doksisiklin 2x100 mg/gün ve seftriakson 1x2 g/gün baflland›. Tedavinin 3. gününde diürezi 6 L/gün'e kadar yükseldi. Trombosit, CPK ve serum kreatinin düzeyleri s›ras›yla tedavinin 3., 5. ve 6. günlerinde normale döndü. Proteinüri giderek azald› ve 15. günde tamamen kayboldu. Antimikrobiyal tedaviye 20 gün devam edildi. Bu arada ELISA ile çok yüksek leptospira IgM ve orta derecede yüksek leptospira IgG saptand›. Sonuç olarak, her ne kadar leptospiral nefropatide temel lezyon tubulointerstisyel nefrit ise de nadiren ABY ile komplike olmufl nefrotik sendrom ile de prezente olabilir. Hipotansiyon, trombositopeni ve CPK art›fl› tan›y› destekleyici sonuçlard›r. Genellikle, nefrotik sendrom ve ABY diyalize gerek kalmadan uygun antimikrobiyal tedavi ile iyileflir.
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