Acute kidney injury in leptospirosis: the Kidney Disease Improving Global Outcomes (KDIGO) criteria and mortality .

Acute kidney injury (AKI) is one of the most serious complications of leptospirosis. In recent years, studies have evaluated this complication using the risk, injury, failure, loss, and end-stage kidney disease and the acute kidney injury network classification systems. More recently, the kidney disease improving global outcomes (KDIGO) criteria have been developed to increase accuracy in detecting AKI. The aim of the present study was to determine the prevalence and factors associated with AKI and mortality in patients with leptospirosis, using KDIGO criteria. We conducted a retrospective analysis of patients with clinical and epidemiological diagnosis of leptospirosis between January 2007 and December 2011. AKI was defined and classified according to KDIGO guidelines. Independent risk factors for AKI and death were evaluated using logistic regression. Of the 205 patients included, only 10 patients (4.8%) exhibited Weil's syndrome. AKI occurred in 182 patients (88.7%), 33 (16.1%) of whom were classified as KDIGO 1, 36 (17.6%) as KDIGO 2, and 113 (55.1%) as KDIGO 3. There was an independent correlation between AKI and the incidence of hyperbilirubinemia and leukocytosis. KDIGO 3 and the need for mechanical ventilation were independently correlated with mortality. We observed a high prevalence of AKI using KDIGO criteria, even in patients with milder forms of leptospirosis. Hyperbilirubinemia and leukocytosis were independent risk factors for AKI. KDIGO 3 was independently associated with mortality.
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