A case of leptospirosis presenting with end-stage renal failure

Atasoyu, Enes Murat; Turhan, Vedat; Ünver, Suat; Evrenkaya, T. Rıfkı; Yıldırım, Şükrü

doi:10.1093/ndt/gfi014

Cited by 20 publications

(21 citation statements)

References 7 publications

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“…In humans, leptospiral infection has been shown to cause tubulointerstitial fibrosis, leading to chronic renal insufficiency and end-stage renal disease requiring hemodialysis (2,4). Although it has been well documented that tubulointerstitial fibrosis is an important consequence of leptospiral infection in animal studies, the mechanism underlying this is poorly defined.…”

Section: Discussionmentioning

confidence: 99%

“…While leptospirosis is well established as a cause of tubulointerstitial fibrosis in dogs and rats, leading to chronic renal failure (28,30), it is also apparent that chronic leptospiral infection may result in renal disease in humans (21). Persistent infection may cause interstitial nephritis and fibrosis in human biopsy samples (21), and more recent studies have demonstrated that this may lead to end-stage renal failure (2). Leptospira santorosai serovar Shermani (referred to hereafter as serovar Shermani) is the main pathogenic leptospira causing renal failure in Taiwan (4).…”

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confidence: 99%

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Leptospira santorosai Serovar Shermani Detergent Extract Induces an Increase in Fibronectin Production through a Toll-Like Receptor 2-Mediated Pathway

Tian

Hung

et al. 2011

Infect Immun

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Leptospirosis can activate inflammatory responses through Toll-like receptors (TLRs) and may cause renal tubulointerstitial fibrosis characterized by the accumulation of extracellular matrix (ECM). We have previously demonstrated that Leptospira santorosai serovar Shermani detergent extract stimulates ECM accumulation in vitro. The aim of this study was to examine the mechanistic basis of these previous observations and, in particular, to examine the potential involvement of TLRs. The addition of serovar Shermani detergent extract led to an increase in fibronectin gene expression and production. Inhibition of TLR2 but not TLR4 expression abrogated serovar Shermani detergent extract-mediated increases in fibronectin production. This response was also blocked by the knockdown of the gene expression of the TLR2 downstream transducers myeloid differentiation factor 88 (MyD88) and tumor necrosis factor receptor-associated factor 6 (TRAF6). Serovar Shermani detergent extract also activated nuclear factor-B, and its inhibition by curcumin-attenuated serovar Shermani detergent extract induced increases in fibronectin production. These effects were also mimicked by the specific TLR2 agonist, Pam(3)CsK(4), a response that was also abrogated by the knockdown of MyD88 and TRAF6. Similarly, the administration of live leptospires to cells also induced fibronectin production that was blocked by inhibition of TLR2 and MyD88 expression. In conclusion, serovar Shermani detergent extract can induce fibronectin production through the TLR2-associated cascade, providing evidence of an association between TLRs and leptospirosis-mediated ECM deposition.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Leptospira santorosai Serovar Shermani Detergent Extract Induces an Increase in Fibronectin Production through a Toll-Like Receptor 2-Mediated Pathway

Tian

Hung

et al. 2011

Infect Immun

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“…From human biopsy studies, chronic infection of leptospirosis has been shown to be associated with chronic interstitial nephritis and fibrosis (8). Recently, it was reported that leptospirosis led to irreversible tubulointerstitial fibrosis in a young male patient, who subsequently required chronic hemodialysis (9). Leptospiral lipoproteins, the membrane component of leptospiral endotoxin that is associated with tubulointerstitial nephritic changes, have been found to be expressed in infected renal tubules and vascular lumen of the interstitium (10).…”

mentioning

confidence: 99%

Leptospiral Outer Membrane Protein Induces Extracellular Matrix Accumulation through a TGF-β1/Smad-Dependent Pathway

Tian¹,

Chen²,

Hung³

et al. 2006

Journal of the American Society of Nephrology

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“…However, a clinical case of a patient with dialysis-requiring-AKI who did not recover his renal function and remained dialysis-dependent was reported [37]. In a study by Covic et al, tubular dysfunction persisted after a 3-month follow up in 30% of patients with severe leptospirosis who completely recovered their glomerular function [26].…”

Section: Discussionmentioning

confidence: 99%

Reversible Myocardial Calcification Following Severe Leptospirosis Complicated With Rhabdomyolysis-Induced Acute Kidney Injury and Magnesium-Wasting Nephropathy

Zakout

2013

J Med Cases

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We present a patient with leptospirosis infection who presented septic shock with multiple-organ dysfunction syndrome, severe rhabdomyolysis and acute myocarditis. He developed biphasic blood calcium pattern with hypocalcemia in the oliguric phase followed by hypercalcemia during the recovery diuretic phase in the context of rhabdomyolysis and oliguric acute kidney injury. Meanwhile, he developed an extensive calcification of the myocardium. Severe renal magnesium wasting was observed during the convalescence phase. Follow-up showed progressive resorption and later almost total disappearance of the calcific deposits in the heart by the 18th month after discharge. Renal magnesium wasting decreased gradually, but yet persisted beyond the 18th and was normalized only by the 36th month after discharge. We discuss the pathophysiologic mechanisms involved in the myocardial calcification and renal magnesium wasting and suggest a possibility of a contributing role of magnesium renal wasting in mobilization of calcium deposits out of myocardium.

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A case of leptospirosis presenting with end-stage renal failure

Cited by 20 publications

References 7 publications

Leptospira santorosai Serovar Shermani Detergent Extract Induces an Increase in Fibronectin Production through a Toll-Like Receptor 2-Mediated Pathway

Leptospira santorosai Serovar Shermani Detergent Extract Induces an Increase in Fibronectin Production through a Toll-Like Receptor 2-Mediated Pathway

Leptospiral Outer Membrane Protein Induces Extracellular Matrix Accumulation through a TGF-β1/Smad-Dependent Pathway

Reversible Myocardial Calcification Following Severe Leptospirosis Complicated With Rhabdomyolysis-Induced Acute Kidney Injury and Magnesium-Wasting Nephropathy

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