Leptospiral-acute kidney injury; an alarming picture in general practice
a systematic review
Journal name: World Journal of Pharmaceutical Research
Original article title: Leptospiral-acute kidney injury; an alarming picture in general practice
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Subtitle: a systematic review
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Tauqeer Hussain Mallhi, Azmi Sarriff, Azreen Syazril Adnan, Yusra Habib Khan, Azhar Amir Hamzah, Fauziah Jummaat, Amer Hayat Khan
World Journal of Pharmaceutical Research:
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Full text available for: Leptospiral-acute kidney injury; an alarming picture in general practice
Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research
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Summary of article contents:
Short summary of the chapter:
Leptospirosis is a widely prevalent zoonotic disease endemic in warm and humid climates, posing significant health challenges across the globe. Its clinical manifestations range from mild infections to severe forms, including Weil's disease, which involves multiple organ dysfunction. A notable complication of leptospirosis is acute kidney injury (AKI), with an incidence of 40-60% in adults and a mortality rate around 22%. This severe condition necessitates increased awareness and appropriate management strategies to reduce morbidity and mortality.
One critical concept discussed is Leptospiral Acute Kidney Injury (LAKI). LAKI is characterized by a spectrum of renal impairments, from mild proteinuria to severe acute renal failure. The pathophysiology involves the injury to renal structures caused by the pathological effects of the Leptospira bacteria, with histological findings primarily indicating acute interstitial nephritis and acute tubular necrosis. Patients with LAKI often exhibit significant electrolyte imbalances, including hypokalemia, and may require intensive monitoring and supportive treatments. The relationship between LAKI severity and increased mortality rates necessitates proactive clinical approaches.
Another essential aspect is the risk factors associated with LAKI. Most cases are reported among male individuals from rural areas who belong to high-risk groups, such as agricultural and veterinary workers exposed to contaminated water sources. The review highlights that prognostic factors, including older age, oliguria, and metabolic derangements, are associated with poor outcomes. Extended hospital stays and complications such as multi-organ failure increase the healthcare burden, emphasizing the need for timely diagnosis and intervention.
The treatment of LAKI predominantly revolves around symptomatic management; however, intravenous penicillin is the gold standard for treating leptospirosis. Despite its efficacy, penicillin does not directly improve renal function in affected patients. Critically ill patients may benefit from advanced supportive therapies, such as hemodialysis and plasma exchange, particularly for those with multi-organ failure. The use of doxycycline for chemoprophylaxis in high-risk individuals can potentially mitigate the incidence of severe cases during outbreaks.
In conclusion, LAKI represents a severe manifestation of leptospirosis that poses significant health risks. The rising incidence of leptospiral infections and associated AKI in endemic regions necessitates increased vigilance and proactive healthcare strategies. Enhanced awareness, timely interventions, and appropriate management can help reduce the burden on health systems and improve patient outcomes. Further research is essential to elucidate the complexities of leptospirosis and its renal complications, paving the way for better-targeted treatments and preventive measures in at-risk populations.
FAQ section (important questions/answers):
What is Leptospirosis and how does it affect the kidneys?
Leptospirosis is a widespread zoonotic infection that can lead to acute kidney injury (AKI). Kidney involvement is common, with 40-60% of cases resulting in LAKI, which can lead to severe complications and increased mortality.
What is the mortality rate associated with Leptospiral AKI?
The mortality rate associated with Leptospiral Acute Kidney Injury (LAKI) is approximately 22%. This rate increases significantly in patients with multi-organ failure and severe forms of AKI.
What are common clinical features of Leptospiral AKI?
Common clinical features include oliguria, hypokalemia, jaundice, thrombocytopenia, and high serum creatinine levels. Patients may also experience multiple organ dysfunction and require increased hospital support.
How long is the average hospital stay for patients with LAKI?
Patients with Leptospiral AKI typically have a hospital stay of 4 to 15 days. Those with severe AKI or multi-organ failure may experience even longer hospitalizations due to complications.
What risk groups are most affected by Leptospirosis?
High-risk groups for leptospirosis include agricultural workers, veterinarians, and those engaged in water sports. Rural residents also have a higher incidence due to environmental exposure.
What treatment options are available for Leptospiral AKI?
There is no specific treatment for Leptospiral AKI, but symptomatic management includes the use of intravenous Penicillin, along with supportive care measures like dialysis for severe cases.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Leptospiral-acute kidney injury; an alarming picture in general practice”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Science (Scientific):
Science is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe. In the context of the study, scientific methods are essential for understanding the complexities of leptospirosis and its association with acute kidney injury, thereby informing clinical practices and interventions.
2) Knowledge:
Knowledge refers to the information, understanding, and skills acquired through experience or education. In relation to leptospirosis and acute kidney injury, knowledge about the disease’s symptoms, transmission, and prevention is crucial for health professionals to make informed decisions and improve outcomes for affected patients.
3) Quality:
Quality signifies the standard of something, reflecting its effectiveness and reliability. In healthcare, quality encompasses the care provided to patients with leptospirosis and acute kidney injury. High-quality care can reduce mortality rates and enhance the overall well-being of patients, emphasizing the need for diligent diagnosis and treatment.
4) Water:
Water is a vital natural resource that plays a crucial role in the transmission of leptospirosis, as it often spreads through contaminated water. Understanding the relationship between water management, rural living conditions, and leptospiral infections is key in developing strategies to control outbreaks and minimize health risks.
5) Agriculture:
Agriculture involves the cultivation of plants and rearing of animals for food production. It is intrinsically linked to the spread of leptospirosis, especially in rural areas where agricultural practices increase the risk of animal-to-human transmission. Awareness of agricultural factors can help in prevention efforts for leptospirosis.
6) Discussion:
Discussion is a formal conversation or debate on a specific topic. In scientific research, discussions enable researchers to interpret data, share insights, and propose new strategies for managing diseases like leptospirosis. This exchange of ideas is essential for advancing understanding and improving patient outcomes.
7) Antibiotic (Antibacterial):
Antibiotics are powerful medications used to fight bacterial infections. In the context of leptospirosis, appropriate antibiotic treatment is crucial for managing the infection, and research highlights the importance of timely and effective antibiotic use to mitigate complications such as acute kidney injury.
8) Debate:
Debate refers to a structured argument or discussion where differing viewpoints are expressed. In medical research, debates about treatment protocols and disease management strategies for leptospirosis, especially regarding acute kidney injury, fuel the advancement of knowledge and lead to improved clinical practices.
9) Hand:
Hand symbolizes intervention and care in healthcare settings. It represents the actions taken by healthcare professionals to manage leptospirosis and its complications. Effective hands-on care, including accurate diagnosis and treatment, is crucial in improving the health outcomes for patients suffering from acute kidney injury.