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Query: UMLS:C0028961 (oliguria)
 1,847 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present paper reports on the results obtained by intravenous administration of furosemide which shortened the period of oliguria in the course of acute renal insufficiency in leptospirosis. The criteria of administration of heparin for preventing the intravascular disseminated coagulation syndrome in leptospirosis are discussed.
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PMID:[Therapeutic considerations on severe leptospirosis]. 13 28

Icterohemorrhagic leptospirosis is a zoonosis which is relatively frequent in rural agricultural or cattle areas. In the severe forms of the disease renal affection is frequent, but the incidence of acute renal insufficiency is far lesser. Three cases of acute renal insufficiency in adult male patients secondary to an infection by Leptospira icterohaemorrhagiae are presented. Two of the patients resided in urban areas and only one of which presented professional risk. The clinical polymorphysm of the illness is confirmed, having observed not only the absence of fever but also that of jaundice. The former history of chronic alcoholism, present in two cases, determined diagnostic difficulties with acute alcoholic hepatitis. The serologic diagnosis is often positive only at the end of the second week, and the need to carry out a series of seroaglutinations is to be insisted upon. The types of renal impairment in leptospirosis are reviewed and the presence of acute renal insufficiency is stressed, including those patients with less severe forms of the disease, and especially those without Weil's syndrome. All of the patients had to be treated with dialysis, although two of them had a conserved diuresis after an initial brief period of oliguria.
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PMID:[Icterohemorrhagic leptospirosis with acute renal failure (author's transl)]. 52 71

The renal profile was studied in 61 patients having leptospirosis. Leptospira-induced acute renal failure conformed to one of two distinct clinical patterns, either oliguric on non-oliguric renal failure. The prognosis was excellent in the latter variety of renal failure and mortality was confined to patients with oliguric renal failure, where severe glomerular and widespread tubulo-interstitial lesions were invariably present. These patients had unfavourable prognostic features during life, such as prolonged oliguria and anuria, absence of a diruetic phase, persistent elevations in BUN and persistently low urea excretion. The prognostic significance of the age of the patients, hypotension and jaundice in relation to the occurrence and type of acute renal failure have been discussed. Retrospective observations indicate that both a vasculotoxic or haemorrhagic state and oliguric acute renal failure are important causes for mortality in human leptospiral infections.
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PMID:Patterns of acute renal failure in leptospirosis. 95 64

Resistant oliguria with increasing serum creatine phosphokinase (CPK) level are the most important early signs of the development of acute renal failure in leptospirosis. This symptomocomplex must be considered as indication for urgent hemosorption. Diuresis and normalisation of creatine phosphokinase level are the criteria for accessing the efficiency of hemosorptions.
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PMID:Urgent hemosorption in leptospirosis. 344 41

Observations in 5 patients dying with leptospirosis (at 6-30 days after the onset) caused by leptospira of the Hebdomadis serogroup are described. Bright jaundice developed due to severe serous liver centrilobular edema with pronounced dissociation of the liver cell bands, cholestasis, and cloudy swelling of hepatocytes. Albuminuria, oliguria, and uraemia were caused by acute tubular and interstitial nephritis. Hemorrhagic diathesis with small bleedings in the skin, mucous and serous membranes was associated with the impairment of permeability of microcirculatory vessels. Focal necroses of skeletal muscles, myocardiodystrophy, and focal myocarditis, serous leptomeningitis were also seen. Few leptospirae could be detected extracellularly (often attached to the outer host cell membranes) by Warthin-Starry's method of silver impregnation of paraffin sections and by indirect immunofluorescence, much more rarely could they be demonstrated by Levaditi's method of silver impregnation of pieces of the viscera. Most leptospirae were present in the liver in the case of death on the 6th day when no antibodies were yet present in the blood. Since the 9th day when the antibodies did appear, leptospirae gradually disappeared from the liver and were found in the kidneys. It is suggested that some leptospiral cytotoxic products play a role in the pathogenesis of leptospirosis.
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PMID:[Clinico-morphological characteristics of leptospirosis]. 688 42

To determine the prognostic factors for leptospirosis, we conducted a retrospective study of data collected in the emergency department of our hospital between 1989 and 1993. Sixty-eight patients, for whom the diagnosis of leptospirosis was based on pertinent clinical and epidemiological data and positive serology, were included in this study. Fifty-six patients (82%) were discharged from the hospital, and 12 (18%) died. Multivariate logistic regression demonstrated that five factors were independently associated with mortality: dyspnea (odds ratio [OR], 11.7; 95% confidence interval [CI], 2.8-48.5; P < .05), oliguria (OR, 9; CI, 2.1-37.9; P < .05); white blood cell count, >12,900/mm3 (OR, 2.5; CI, 1.8-3.5; P < or = .01), repolarization abnormalities on electrocardiograms (OR, 5.9; CI, 1.4-24.8; P < or = .01), and alveolar infiltrates on chest radiographs (OR, 7.3; CI, 1.7-31.7; P < or = .01). Identification of these factors on admission might provide useful selection criteria for patients who need early transfer to the intensive care unit.
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PMID:Leptospirosis: prognostic factors associated with mortality. 931 67

The risk factors for death and changes in clinical patterns in leptospirosis (Weil's disease) have not been well studied. We retrospectively studied 110 patients with Weil's disease hospitalized in Brazil between 1985 and 1996. Univariate statistical analysis showed that nonsurvivors were older than survivors, and had higher frequency of oliguria, cardiac arrhythmia, dyspnea, and pulmonary rales. Logistic regression showed that the only independent factor associated with death was oliguria (odds ratio [OR] = 8.98). The presence of arthralgia (OR = 4.71), dehydration (OR = 6.26), dyspnea (OR = 17.7), and pulmonary rales (OR = 9.91) increased after 1994. These data suggest that in Weil's disease the clinical patterns have changed and the presence of oliguria is a risk factor for death.
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PMID:Risk factors for death and changing patterns in leptospirosis acute renal failure. 1054 99

BACKGROUND: Leptospirosis (LS) and Hantavirus (HV) infection have many common clinical manifestations, including acute renal failure. In as much as clinical experience with these diseases is quite limited in urban centers, we identified cases of Leptospira and HV-induced acute renal failure and compared the clinical course and evolution of these diseases. METHODS: Patients hospitalized with acute renal failure, suspected to be caused by infection, were retrospectively studied over a 13-year period (1985-1998). Based on pertinent clinical data and positive serology, a total of 26 patients were included in the study, 17 patients with LS and 9 patients with HV infection. RESULTS: Both diseases presented as flu-like syndromes with high fever. In LS, 2 patients presented with acute meningitis and died soon after admission. Symptoms and signs from other organs began after the fifth day of illness. Jaundice occurred in 71% of LS patients but not in HV. Hemorrhagic phenomena occurred in both diseases but affected predominantly patients with icteric LS. Anuria or oliguria occurred in 76% of patients with LS and 78% with HV infection. Laboratory studies demonstrated minor transaminase elevations in all patients with LS and in 44% with HV. Hypoprothrombinemia or thrombocytopenia was uncommon, although disseminated intravascular coagulation (DIC) developed in 2 patients that had icteric Ls and major bleeding. Nephropathy was associated with haematuria in 71% with LS and all patients with HV. Proteinuria was evident in 35% of patients with LS compared to 78% with HV. Abnormal chest radiographs were seen in 24% with LS and in 33% with HV. In both diseases, aggressive supportive treatment was given, including hemodialysis or peritoneal dialysis in 4/26 patients. Of the 26 patients, 22 survived and four died. The latter all had LS, and the causes of death were meningitis and DIC with multiple organ failure. Follow-up, after 6 months, showed that renal function had returned to normal in the 22 survivors. CONCLUSION: It is important to include LS and HV infection in the differential diagnosis of acute renal failure. Both diseases present with flu-like symptoms and may be complicated by thrombotic microangiopathy with hemorrhagic phenomena and hepatic and pulmonary involvement. Jaundice should alert the physician to icteric LS, a severe disease associated with significant mortality that requires antimicrobial treatment.
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PMID:Acute renal failure caused by leptospirosis and Hantavirus infection in an urban hospital. 1206 23

Leptospirosis is an infectious disease caused by pathogenic leptospires and is characterized by a broad spectrum of clinical manifestations, varying from inappearent infection to fulminant, fetal disease. Eighty-five to 90% of leptospirosis infections are self-limiting. However, 5-10% of infection by L. interrogans can cause renal tubular damage, microvascular injury, acute renal failure (ARF), and interstitial nephritis. We studied 36 patients with leptospirosis. Twenty-seven (65%) cases of 36 patients had ARF. Fourteen (51%) had nonoliguric ARF. In thirteen (48%) oliguria appeared on the third or fourth days of hospitalization. Serum BUN, creatinine, serum bilirubine, ALT, AST, potassium and thrombocytopenia levels were higher in oliguric than nonoliguric patients (p < 0.05). However, serum sodium, CPK levels were not different between oliguric and nonoliguric groups (p > 0.05). Thirteen patients (48%) needed in renal replacement therapy (RRT). 8 of them were treated by hemodialysis (HD) alone and 5 patients by HD in combination with hemoperfusion. Twenty-five patients (92%) recovered completely after 3-5 weeks. Two patients (7.4%) who had severe hepatorenal and hemorrhagic syndromes, died. We concluded that till now leptospirosis is actual problem for nephrologist in the developing countries because of very high percentage of renal disease, with good prognosis in patients without multiorgan failure and early treatment.
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PMID:Acute renal failure in leptospirosis in the black-sea region in Turkey. 1209 Mar 20

An outbreak of leptospirosis occurred during the rainy season in the city of Mumbai, India. Out of 169 suspected cases, 74 (43.7%) were determined serologically positive by microagglutination test (MAT) carried out with a battery of eight pathogenic serovars, while 78 (46.1%) were shown positive for IgM antibodies to leptospira by enzyme-linked immunosorbent assay. On the basis of MAT, serovar Copenhageni accounted for 66 (89.1%) out of the 74 cases admitted during the period of the outbreak. Myalgia, conjunctival suffusion, cough with hemoptysis, icterus, and oliguria were significantly more common in patients whose samples were determined positive by MAT. The presence of pulmonary signs and symptoms and renal failure were significantly associated with mortality in patients presumed to be suffering from leptospirosis.
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PMID:An urban outbreak of leptospirosis in Mumbai, India. 1260 28


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