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.
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.
Seguro AC, Lomar AV, Rocha AS, 1990. Acute renal failure of leptospirosis: nonoliguric and hypokalemic forms. Nephron 55 :146–151.
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.
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.
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.
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.
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.
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.
Berkelhammer C, Bear RA, 1985. A clinical approach to common electrolyte problems: 4. Hypomagnesemia. Can Med Assoc J 132 :360–368.
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.
Tong GM, Rude RK, 2005. Magnesium deficiency in critical illness. J Intensive Care Med 20 :3–17.
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.
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.
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.
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.
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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.