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首页> 外文期刊>Clinical and diagnostic laboratory immunology >Potential Benefit of Plasma Exchange in Treatment of Severe Icteric Leptospirosis Complicated by Acute Renal Failure
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Potential Benefit of Plasma Exchange in Treatment of Severe Icteric Leptospirosis Complicated by Acute Renal Failure

机译：血浆置换治疗重症急性肾功能不全钩端螺旋体病并发急性肾衰竭的潜在益处

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摘要

Leptospirosis is a common zoonosis seen worldwide, but it is rare in our locality (Hong Kong). Clinical manifestations of leptospirosis are variable and may range from subclinical infection to fever, jaundice, hemorrhagic tendency, and fulminant hepato-renal failure. Severe hyperbilirubinemia and acute renal failure have been associated with high mortality. We report our experience with a patient who developed severe Weil's syndrome with marked conjugated hyperbilirubinemia and oliguric acute renal failure. These complications persisted despite treatment with penicillin and hemodiafiltration. Plasma exchange was instituted in view of the severe hyperbilirubinemia (970 μmol/liter). This was followed by prompt clinical improvement, with recovery of liver and renal function. The beneficial effects of plasma exchange could be attributed to amelioration of the toxic effects of hyperbilirubinemia on hepatocyte and renal tubular cell function. We conclude that plasma exchange should be considered as an adjunctive therapy for patients with severe icteric leptospirosis complicated by acute renal failure who have not shown rapid clinical response to conventional treatment.
机译：钩端螺旋体病是世界范围内常见的人畜共患病，但在我们当地（香港）很少见。钩端螺旋体病的临床表现各不相同，范围从亚临床感染到发烧，黄疸，出血倾向和暴发性肝肾衰竭。严重的高胆红素血症和急性肾衰竭与高死亡率相关。我们报告了我们的经验，该患者患有严重的Weil综合征，伴有明显的共轭高胆红素血症和少尿性急性肾衰竭。尽管用青霉素和血液透析滤过治疗，这些并发症仍然持续。考虑到严重的高胆红素血症（970μmol/升），开始进行血浆置换。随后迅速进行临床改善，肝和肾功能得以恢复。血浆置换的有益作用可以归因于高胆红素血症对肝细胞和肾小管细胞功能的毒性作用的改善。我们得出的结论是，对于严重的黄疸性钩端螺旋体病并发急性肾衰竭的患者，血浆置换应被视为辅助治疗，而传统治疗并未显示出快速的临床反应。

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