Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis?

Martinelli, Reinaldo; Luna, Marcos A.; Rocha, Heonir

doi:10.1590/S0036-46651994000200003

Abstracts

Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120µg/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.

Renal failure; Rhabdomyolysis; Leptospirosis

Leptospirose é uma importante causa de insuficiência renal aguda, em nosso ambiente. Embora vários sejam os mecanismos implicados, o papel da rabdomiólise na patogênese da insuficiência renal aguda na leptospirose ainda não foi analisado. Com esse objetivo, 16 pacientes com o diagnóstico da forma icterohemorrágica da leptospirose consecutivamente admitidos no Hospital Couto Maia, Salvador, Bahia, foram prospectivamente estudados. A doença foi caracterizada por início súbito e, à admissão, ictericia, sufusões hemorrágicas conjuntivais e mialgias. Proteinúria de intensidade média a moderada com sedimento urinário inexpressivo foi observada em 37,5% dos pacientes e níveis séricos elevados de uréia e creatinina em 78,5% e 74,0%, respectivamente. Níveis aumentados de aminotransferase foram documentados em todos os 12 e de CPK em todos os 10 pacientes avaliados para essas enzimas. Níveis séricos maiores que 120µg/l foram observados em 56,2% dos pacientes. Não foram encontradas correlações, entretanto, entre mioglobinemia e insuficiência renal em gravidade da leptospirose.

MICROBIOLOGY

Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis ?

É a rabdomiólise um fator adicional na patogônese da insuficiencia renal aguda na leptospirose?

Reinaldo Martinelli; Marcos A. Luna; Heonir Rocha

Disciplina de Nefrologia, Departamento de Medicina - Faculdade de Medicina, Universidade Federal da Bahia - Salvador - Bahia

^{Correspondence to} Correspondence to: Reinaldo Martinelli Hospital Universitário Prof. Edgard Santos, Laboratório de Nefrologia 1117 Rua João das Botas, s/n -Canela 40110-160 - Salvador - Bahia - Brasil

SUMMARY

Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120µg/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.

Keywords: Renal failure; Rhabdomyolysis; Leptospirosis.

RESUMO

Leptospirose é uma importante causa de insuficiência renal aguda, em nosso ambiente. Embora vários sejam os mecanismos implicados, o papel da rabdomiólise na patogênese da insuficiência renal aguda na leptospirose ainda não foi analisado. Com esse objetivo, 16 pacientes com o diagnóstico da forma icterohemorrágica da leptospirose consecutivamente admitidos no Hospital Couto Maia, Salvador, Bahia, foram prospectivamente estudados. A doença foi caracterizada por início súbito e, à admissão, ictericia, sufusões hemorrágicas conjuntivais e mialgias. Proteinúria de intensidade média a moderada com sedimento urinário inexpressivo foi observada em 37,5% dos pacientes e níveis séricos elevados de uréia e creatinina em 78,5% e 74,0%, respectivamente. Níveis aumentados de aminotransferase foram documentados em todos os 12 e de CPK em todos os 10 pacientes avaliados para essas enzimas. Níveis séricos maiores que 120µg/l foram observados em 56,2% dos pacientes. Não foram encontradas correlações, entretanto, entre mioglobinemia e insuficiência renal em gravidade da leptospirose.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Recebido para publicação em 22/06/1993.

Aceito para publicação em 21/01/1994.

The study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq (Grant 400711/85).

1. CAINS, J.A.; MISSIRLIS, E. & WELBER, W.H.C. - Usefulness of serial determination of myoglobin and creatine kinase in serum compared for the assessment of acute myocardial infarction. Clin. Chem., 29: 469-473, 1983.
2. FEINFELD, D.A.; CHENY, J.T.; BEYSOLOW, T.D. & BRISCOE, A.M. - A prospective studies of urine and serum myoglobin levels in patients with acute rhabdomyolysis. Clin. Nephrol., 38: 193-195, 1992.
3. FEINFELD, D.A.; BRISCOE, A.M.; NURSE, H.M.; HOTCHKISS, J.L. & THOMSOM, G.E. - Myoglobin in chronic renal failure. Amer. J. Kidney Dis., 8: 111-114, 1986.
4. GABOW, P.A.; KAEHNY, W.D. & KELLEHER, S.B.P. - The spectrum of rhabdomyolysis. Medicine (Baltimore), 61: 141-152, 1982.
5. GROSSMAN, R.A.; HAMILTON, R.W.; MORSE, B.M.; PENN, A.S. & GOLDBERG, M. - Non-traumatic rhabdomyolysis and acute renal failure. New Eng. J. Med., 291: 807-811, 1974.
6. GUEDES E SILVA, J.B.; PAIVA, L.M.; PEREIRA DA SILVA, J.J.; BARRETTO NETTO, M. & COURA, J.P. - A biópsia muscular no diagnóstico das leptospiroses. Rev. Soc. bras. Med. trop., 3: 305-316, 1969.
7. GUEDES E SILVA, J.B.C.; PAIVA, L.M.; SILVA, J.J.P. & NETTO, B.A. - Pathological involvement of human gastrocnemius muscle in leptospirosis (a study in 63 patients). Rev. bras. Pesq. méd. Biol., 13: 9-13, 1980.
8. HAMILTON, R.W.; HOPKINS, M.B. & SHIHABI, Z.K. - Myoglobinuria, hemoglobinuria and acute renal failure. Clin. Chem., 35: 1713-1720, 1989.
9. HESS, J.W.; MacDONALD, R.P.; FREDERICK, R.J. et al. - Serum creatine phosphokinase (CPK) in disorders of heart and skeletal muscle. Ann. intern. Med., 61: 1015-1020, 1964.
10. HO, K.J. & SCULLY, K.T. - Acute rhabdomyolysis and renal failure in Weil's disease. Ala. J. med. Sci., 17: 133-137, 1980.
11. HONDA, N. - Acute renal failure and rhabdomyolysis. Kidney Int., 23: 888-898, 1983.
12. JOHNSON Jr., W.S.; SILVA, I.C. & ROCHA, H. - Serum creatinine phosphakinase in leptospirosis. J. Amer. med. Ass., 233: 981-982, 1975.
13. KAGEN, L.; CHEIDT, S.; ROBERTS, L.; PARTER, A. & PAUL, H. - Myoglobinemia following acute myocardial infarction. Amer. J. Med., 58: 177-182, 1975.
14. KNOCHEL, J.P. - Rhabdomyolysis and myoglobinuria. Semin. Nephrol., 1: 75-86, 1981.
15. KOSKELO, P.; KEKKI, M. & WAGER, O. - Kinetics behaviour of 125I labelled myoglobin in humans beings. Clin. chim. Acta, 17: 339-347, 1967.
16. LORDON, Q.E. & BURTON, J.R. - Post-traumatic renal failure in military personell in shoutheast Asia. Amer. J. Med., 53: 137-147, 1972.
17. MACHADO, R. & COSTA, E. - Leptospirose em Salvador: alguns aspectos clínicos e epidemiológicos. Rev. méd. Bahia, 23: 194-207, 1977.
18. MAGALDI, A.J.; YASUDA, P.N.; KUDA, L.H.; SEGURO, A.C. & ROCHA, N.J. - Renal involvement in leptospirosis: a pathophy-siologic study. Nephron, 62: 332-339, 1992.
19. MILNE, C.J. - Rhabdomyolysis, myoglobinuria and exercises. Sport Med., 6: 93-106, 1988.
20. SILVA, I.C. & ROCHA, H. - Aspectos clínicos do envolvimento renal na leptospirose. Rev. méd. Bahia, 21: 5-12, 1976.
21. SITPRIJA, V.; MERTOWIDJOJO, K.; BOONPUCKNAVIG, V. & BOONPUCKNAVIG, S. - Pathogenesis of renal disease in leptospirosis: clinical and experimental studies. Kidney Int., 17: 827-836, 1980.

Correspondence to:

Reinaldo Martinelli

Hospital Universitário Prof. Edgard Santos, Laboratório de Nefrologia 1117

Rua João das Botas, s/n -Canela

40110-160 - Salvador - Bahia - Brasil

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
Apr 1994

History

Accepted
21 Jan 1994
Received
22 June 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. CAINS, J.A.; MISSIRLIS, E. & WELBER, W.H.C. - Usefulness of serial determination of myoglobin and creatine kinase in serum compared for the assessment of acute myocardial infarction. Clin. Chem., 29: 469-473, 1983.

[2] 2. FEINFELD, D.A.; CHENY, J.T.; BEYSOLOW, T.D. & BRISCOE, A.M. - A prospective studies of urine and serum myoglobin levels in patients with acute rhabdomyolysis. Clin. Nephrol., 38: 193-195, 1992.

[3] 3. FEINFELD, D.A.; BRISCOE, A.M.; NURSE, H.M.; HOTCHKISS, J.L. & THOMSOM, G.E. - Myoglobin in chronic renal failure. Amer. J. Kidney Dis., 8: 111-114, 1986.

[4] 4. GABOW, P.A.; KAEHNY, W.D. & KELLEHER, S.B.P. - The spectrum of rhabdomyolysis. Medicine (Baltimore), 61: 141-152, 1982.

[5] 5. GROSSMAN, R.A.; HAMILTON, R.W.; MORSE, B.M.; PENN, A.S. & GOLDBERG, M. - Non-traumatic rhabdomyolysis and acute renal failure. New Eng. J. Med., 291: 807-811, 1974.

[6] 6. GUEDES E SILVA, J.B.; PAIVA, L.M.; PEREIRA DA SILVA, J.J.; BARRETTO NETTO, M. & COURA, J.P. - A biópsia muscular no diagnóstico das leptospiroses. Rev. Soc. bras. Med. trop., 3: 305-316, 1969.

[7] 7. GUEDES E SILVA, J.B.C.; PAIVA, L.M.; SILVA, J.J.P. & NETTO, B.A. - Pathological involvement of human gastrocnemius muscle in leptospirosis (a study in 63 patients). Rev. bras. Pesq. méd. Biol., 13: 9-13, 1980.

[8] 8. HAMILTON, R.W.; HOPKINS, M.B. & SHIHABI, Z.K. - Myoglobinuria, hemoglobinuria and acute renal failure. Clin. Chem., 35: 1713-1720, 1989.

[9] 9. HESS, J.W.; MacDONALD, R.P.; FREDERICK, R.J. et al. - Serum creatine phosphokinase (CPK) in disorders of heart and skeletal muscle. Ann. intern. Med., 61: 1015-1020, 1964.

[10] 10. HO, K.J. & SCULLY, K.T. - Acute rhabdomyolysis and renal failure in Weil's disease. Ala. J. med. Sci., 17: 133-137, 1980.

[11] 11. HONDA, N. - Acute renal failure and rhabdomyolysis. Kidney Int., 23: 888-898, 1983.

[12] 12. JOHNSON Jr., W.S.; SILVA, I.C. & ROCHA, H. - Serum creatinine phosphakinase in leptospirosis. J. Amer. med. Ass., 233: 981-982, 1975.

[13] 13. KAGEN, L.; CHEIDT, S.; ROBERTS, L.; PARTER, A. & PAUL, H. - Myoglobinemia following acute myocardial infarction. Amer. J. Med., 58: 177-182, 1975.

[14] 14. KNOCHEL, J.P. - Rhabdomyolysis and myoglobinuria. Semin. Nephrol., 1: 75-86, 1981.

[15] 15. KOSKELO, P.; KEKKI, M. & WAGER, O. - Kinetics behaviour of 125I labelled myoglobin in humans beings. Clin. chim. Acta, 17: 339-347, 1967.

[16] 16. LORDON, Q.E. & BURTON, J.R. - Post-traumatic renal failure in military personell in shoutheast Asia. Amer. J. Med., 53: 137-147, 1972.

[17] 17. MACHADO, R. & COSTA, E. - Leptospirose em Salvador: alguns aspectos clínicos e epidemiológicos. Rev. méd. Bahia, 23: 194-207, 1977.

[18] 18. MAGALDI, A.J.; YASUDA, P.N.; KUDA, L.H.; SEGURO, A.C. & ROCHA, N.J. - Renal involvement in leptospirosis: a pathophy-siologic study. Nephron, 62: 332-339, 1992.

[19] 19. MILNE, C.J. - Rhabdomyolysis, myoglobinuria and exercises. Sport Med., 6: 93-106, 1988.

[20] 20. SILVA, I.C. & ROCHA, H. - Aspectos clínicos do envolvimento renal na leptospirose. Rev. méd. Bahia, 21: 5-12, 1976.

[21] 21. SITPRIJA, V.; MERTOWIDJOJO, K.; BOONPUCKNAVIG, V. & BOONPUCKNAVIG, S. - Pathogenesis of renal disease in leptospirosis: clinical and experimental studies. Kidney Int., 17: 827-836, 1980.