ON THE MECHANISM OF IMPAIRMENT OF THE KIDNEYS IN LEPTOSPIROSIS

Abstract

THEAIM of the work was to determine the mechanisms of the kidneys in leptospirosis in order to improve the diagnosis, prognosis of the course and pathogenetical therapy of the patients. PATIENTSAND METHODS. General clinical, instrumental (USI, renoscintigraphy) and biochemical investigations were carried on to characterize the kidney function in 451 leptospirosis patients (leptospiral jaundice in 67.2%, bovine leptospirosis - in 32.8%). Myoglobin in blood and urine was determined in 59 leptospirosis patients and in suspensions of the kidneys (in 5 dead from leptospirosis (control groups - patients with acute viral hepatitis B (AVHB), acute renal failure (ARF) of nonleptospirosis etiology, healthy donors and the dead from cerebro-cranial injuries). Pathomorphological alterations in the kidneys were analyzed in 34 dead from leptospirosis and 10 - from AVHB. RESULTS. One of the links of ARF in leptospirosis is rhabdomyolysis resulting in myoglobinuric nephropathy shown in the oligoanuric stage by high indices of myoglobin in blood and renal tissue in autopsy in combination with a low level of myoglobin in urine. It is expedient to include means promoting early liquidation of endotoxicosis and myoglobinemia in pathogenetic therapy of leptospirosis patients. The indices of urine acidity and the coefficient of the blood and urine myoglobin ratio can be taken as a criterion for choosing detoxication methods (conservative or efferent). CONCLUSION. A new important mechanism of the formation of renal syndrome at the height of leptospirosis is substantiated which is related with the elimination by the kidneys of the unusual for blood myoglobin protein formed in high concentrations at specific leptospiral rhabdomyolysis. The ARF developing in the acute period of leptospirosis is reversible under conditions of the rational treatment of the patients.