Leptospirosis Renal Disease - Causes, Symptoms, and Prevention

Introduction:

Leptospirosis is a rare bacterial infection transmitted from animals. It is spread through urine, especially by dogs, rodents, and domestic animals. People can be asymptomatic carriers of this disease. The bacterium which causes leptospirosis is called Leptospira interrogans. Many wild and domesticated animals carry this organism in their kidneys. It enters the soil and water through their urine. Leptospirosis is more common in temperate climates. This bacterium lives all over the world but is especially common in Australia, Africa, Southeast Asia, Central and South America, and the Caribbean. Vaccination against leptospirosis in animals protects a large number of farm animals and pets from getting infected with leptospirosis.

What Is Leptospirosis Renal Disease?

Leptospirosis is characterized by sudden fever, muscle aches, increased blood accumulation in the outer lining of the eyeballs, and renal dysfunction. Kidney dysfunction can range from mild-to-severe acute kidney injury to chronic kidney disease (CKD) requiring dialysis. Chronic infection with leptospirosis can progress to renal fibrosis and subsequent renal failure.

What Are the Causes of Leptospirosis Renal Disease?

The etiology of leptospirosis renal disease is associated with chronic tubulointerstitial nephritis (inflammation inside the kidneys). Leptospirosis causes dysregulation of renal sodium transport and decreased aquaporin-2 expression in the kidney, resulting in polyuria (kidneys create an excess amount of urine) and natriuresis (sodium excretion from the urine). Renal failure and hypokalemia (low blood potassium levels) are common due to tubular damage with impaired transport of tubular epithelial cells.

Who Is at Risk of Leptospirosis Renal Disease?

Leptospirosis occurs throughout the world but is most common in temperate or tropical climates. This is an occupational hazard for people who work with animals or when work involves dealing with household waste such as:

• Farmers.

• Miners.

• Sewer workers.

• Slaughterhouse worker.

• Veterinarians and animal keepers.

• Fish workers.

• Dairy farmers.

• Soldiers.

Leptospirosis is also associated with swimming, wading, kayaking, and rafting in polluted lakes and rivers. It is a hazard for those who camp or participate in outdoor sports. Those participating in these activities in tropical or temperate climates may be at an increased risk.

What Are the Symptoms of Leptospirosis Renal Disease?

The various symptoms elicited by leptospirosis renal disease are:

• Hematuria (blood in the urine).

• Foamy urine (due to the presence of excess amounts of protein in the urine).

• High blood pressure.

• Swelling of hands, ankles, or feet.

• High amounts of a waste product called creatinine in the blood.

What Are the Possible Complications of Leptospirosis Renal Disease?

The possible complications of leptospirosis renal disease:

• Hypertension (high blood pressure).

• High cholesterol.

• Blood clots include deep vein thrombosis (clot formation in the blood vessels of legs) or pulmonary embolism (clot in the lungs).

• Severe multi organ damage.

• Chronic kidney disease.

• Renal insufficiency (improper functioning of both kidneys).

When to Get Help for Leptospirosis Renal Disease?

People should contact a doctor when the following symptoms are elicited:

• Fever.

• Headache.

• Cough.

• Diarrhea.

• Cold.

• Vomiting.

• Red eyes.

• Stomach ache.

• Muscle pain (especially in the calves and lower back).

• A non-itchy rash (usually on the shins).

How Is Leptospirosis Renal Disease Diagnosed?

The following methods help diagnose leptospirosis renal disease:

• Blood and Urine Tests - In addition to the standard blood and urine tests, the patient may be asked to collect urine throughout the day. These tests measure how well the kidneys are functioning.

• Renal Biopsy - A biopsy, in which a doctor removes a small piece of kidney tissue for analysis in the laboratory, is the most definitive test for diagnosing nephritis caused by leptospirosis. It also helps determine the severity of the disease.

• Imaging - Enlarged kidney in the ultrasound is a sign of chronic tubulointerstitial nephritis.

• Microscopic Agglutination Test (MAT) - It is the standard test for the sero diagnosis of leptospirosis. It checks for the presence of bacteria in a person’s serum.

• IgM Enzyme-Linked Immunosorbent Assay (ELISA) - It may be performed to confirm leptospirosis.

How Is Leptospirosis Renal Disease Treated?

Simple measures can help treat mild cases of leptospirosis. These include:

• Drinking plenty of fluids.

• Getting enough rest.

• Taking over-the-counter (OTC) pain relievers such as Acetaminophen.

• Administration of intravenous fluid to maintain the salt and water levels of the body.

• Dialysis to prevent accumulation of toxic wastes in the body.

Physicians also prescribe antibiotics to treat leptospirosis and they may be administered intravenously for cases of severe leptospirosis. Examples of antibiotics include:

the following antibiotics to treat leptospirosis renal disease.

• Doxycycline.

• Azithromycin.

• Amoxicillin.

• Penicillin and Ceftriaxone (for severe cases).

How to Prevent Leptospirosis Renal Disease?

The prevention of leptospirosis itself may stop the occurrence of the renal disease associated with it. The following steps can be taken for prevention:

• Clean Drinking Water - People in developing countries should consume clean and properly treated water.

• Keep Away From Infected Animals - Wild rats, mice, and other rodents are the main reservoirs of bacteria. Even in the western world, 20% of wild rats are affected. One should be careful when handling feral rats or coming into contact with their habitat.

• Vaccination of Pets - Livestock and pets are usually required to be vaccinated, and it lowers the risk much. If the animal is sick, avoid bites and coming in contact with the body fluids. The disease is not spread through air like colds and flu.

• Use Disinfectant - Bleach, acid solutions, and iodine are deadly to bacteria. They should be used to clean up the living area and surroundings which are frequented by these animals.

• Avoiding Swimming in Water - Swimming in freshwaters, such as rivers, ponds, and lakes which could be compromised by animal urine. Avoid swimming in water bodies after heavy rainfall or flooding.

• Protection From Contaminated Water - Wear protective gloves or footwear while working or navigating infected water or soil or running with animals.

How to Avoid Leptospirosis from Pets and Farm Animals?

If the pet has leptospirosis, people can do the following to shield themselves:

• Give their pet the prescribed antibiotics as advised by the veterinarian.

• Avoid coming in contact with the pet’s urine.

• Pet urine in the house premises should be cleaned immediately, and the area disinfected.

• Pets should be made to urinate and defecate some distance away from water bodies or locations that are frequented by people frequently.

• Hand hygiene should be maintained thoroughly.

• Pet owners should take their pets for regular checkups to the veterinarian.

• Keep the pets far from rodents, wild animals, and animal corpses.

• Ensure that the pets drink clean water.

• If possible, hold pets far from other animals’ urine.

• Ask the veterinarian if the pet needs a leptospirosis vaccine.

• Keep the pets from coming in contact with stagnated water as it could be possibly infected water after heavy rainfall or flooding.

• Infected farm animals should be isolated immediately from other animals.

• The farm animal facility should be airy and spacious, following all hygiene protocols.

Conclusion:

Leptospirosis is a bacterial contamination affecting human beings and animals. It can also lead to numerous symptoms in humans, which may be a sign of different diseases. However, a few cases of leptospirosis do not show any signs. Leptospirosis causing acute interstitial nephritis (inflammation in kidneys) may cause not only asymptomatic urine changes but also may cause permanent kidney damage and failure. Patients may require dialysis or a kidney transplant in severe complications of leptospirosis. Vaccination against leptospirosis in animals protects a large number of farm animals and pets from getting infected with leptospirosis.