Volume 79, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


We report a case of severe hypomagnesemia in non-oliguric acute renal failure caused by leptospirosis that required large doses of magnesium replacement during the acute phase of disease. Biochemical studies confirmed kidney-related magnesium wasting and the mechanisms of this defect are discussed. Magnesium imbalance with its attendant clinical complications occurs in leptospirosis and should be monitored and treated aggressively in cases of leptospirosis-induced non-oliguric acute kidney injury.


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  1. Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM; Peru-United States Leptospirosis Consortium, 2003. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 3 : 757–771. [Google Scholar]
  2. Spichler A, Athanazio D, Buzzar M, Castro B, Chapolla E, Seguro A, Vinetz JM, 2007. Using death certificate reports to find severe leptospirosis cases, Brazil. Emerg Infect Dis 13 : 1559–1561. [Google Scholar]
  3. Seguro AC, Lomar AV, Rocha AS, 1990. Acute renal failure of leptospirosis: nonoliguric and hypokalemic forms. Nephron 55 : 146–151. [Google Scholar]
  4. Yang CW, Wu MS, Pan MJ, Hong JJ, Yu CC, Vandewalle A, Huang CC, 2000. Leptospira outer membrane protein activates NF-κB and downstream genes expressed in medullary thick ascending limb cells. J Am Soc Nephrol 11 : 2017–2026. [Google Scholar]
  5. Wu MS, Yang CW, Pan MJ, Chang CT, Chen YC, 2004. Reduced renal Na+-K+-Cl- co-transporter activity and inhibited NKCC2 mRNA expression by Leptospira shermani: from bedside to bench. Nephrol Dial Transplant 19 : 2472–2479. [Google Scholar]
  6. Andrade L, Rodrigues AC Jr, Sanches TR, Souza RB, Seguro AC, 2006. Leptospirosis leads to dysregulation of sodium transporters in the kidney and lung. Am J Physiol Renal Physiol 292 : F586–F592. [Google Scholar]
  7. Spichler A, Ko AI, Silva EF, De Brito T, Silva AM, Athanazio D, Silva C, Seguro A, 2007. Reversal of renal tubule transporter down-regulation during severe leptospirosis with antimicrobial therapy. Am J Trop Med Hyg 77 : 1111–1119. [Google Scholar]
  8. de Jorge FB, 1970. Concentration of copper, ceruloplasmin, magnesium and sulfate in the blood of patients with a hepatorenal form of Weil’s disease. Rev Bras Med 27 : 449–451. [Google Scholar]
  9. Khositseth S, Sudjaritjan N, Tananchai P, Ongajyuth S, Sitprija V, Thongboonkerd V, 2007. Renal magnesium wasting and tubular dysfunction in leptospirosis. Nephrol Dial Transplant 23 : 952–958. [Google Scholar]
  10. Berkelhammer C, Bear RA, 1985. A clinical approach to common electrolyte problems: 4. Hypomagnesemia. Can Med Assoc J 132 : 360–368. [Google Scholar]
  11. Gunnerson KJ, Kellum JA, 2003. Acid-base and electrolyte analysis in critically ill patients: are we ready for the new millennium? Curr Opin Crit Care 9 : 468–473. [Google Scholar]
  12. Tong GM, Rude RK, 2005. Magnesium deficiency in critical illness. J Intensive Care Med 20 : 3–17. [Google Scholar]
  13. Abdulkader RC, Seguro AC, Malheiro PS, Burdmann EA, Marcondes M, 1996. Peculiar electrolytic and hormonal abnormalities in acute renal failure due to leptospirosis. Am J Trop Med Hyg 54 : 1–6. [Google Scholar]
  14. Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Seica A, Covic M, 2003. A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature. Nephrol Dial Transplant 18 : 1128–1134. [Google Scholar]
  15. Ko AI, Galvao Reis M, Ribeiro Dourado CM, Johnson WD Jr, Riley LW, 1999. Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet 354 : 820–825. [Google Scholar]
  16. Esen S, Sunbul M, Leblebicioglu H, Eroglu C, Turan D, 2004. Impact of clinical and laboratory findings on prognosis in leptospirosis. Swiss Med Wkly 134 : 347–352. [Google Scholar]
  • Received : 08 Jun 2008
  • Accepted : 20 Aug 2008

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