Letter to the Editor: “Peritoneal Dialysis in Leptospirosis-Induced Acute Renal Failure: An Appraisal on Thai Patients”

Leptospirosis is an important infection that is endemic in many developing tropical countries. Renal involvement is common in leptospirosis.[1] Clinical manifestations vary from urinary sediment changes to acute renal failure (ARF).[1] ARF can be observed in malarial patients who had heavy infection of leptospirosis. Tubular necrosis and interstitial nephritis are responsible for renal failure.[1] Hemodynamic alterations, immune response, and direct nephrotoxicity are responsible for the development of renal lesions.[1] As in many infectious diseases, decreased renal blood flow and glomerular filtration rate play a basic role.[1] Similar to other types of renal failure, dialysis should be considered when there is a rapid increase of creatinine concentration.

Here, the author performs this ministudy to summarize the outcomes of peritoneal dialysis (PD) among reported Thai cases with leptospirosis-induced ARF. A literature review on the papers concerning PD among Thai patients with leptospirosis-induced ARF was performed from database of the published works cited in the Index Medicus and Science Citation Index and also the published works in all 256 local Thai journals, which are not included in the international citation index. The reports that contained no complete data were excluded for further analysis.

According to this review, there were three reports[2–4] covering 14 Thai patients (age range = 12–68 years old) who had PD according to leptospirosis-induced ARF. Of these 14 patients, 9 (64.3%) patients had nonoliguric renal failure. All patients also received standard antibiotic therapy accompanied by PD. Of the 14 patients, 1 died (7.1%). The death case died from circulatory failure and uremia. There was no association between the day of illness when PD was begun and mortality rates. These observations suggest that PD is beneficial in treating ARF associated with leptospirosis even in cases with oliguria. PD is also useful for the rural endemic setting where hemodialysis is unavailable.