Prediction of Clinical Features and Outcome of Leptospirosis associated AKI according to Acute Kidney Injury Net work Classification in a Tertiary Care Hospital of Bangladesh.

Acute kidney injury (AKI) is a common complication of leptospira infection. The changes in renal function during leptospira infection are related to prognosis and mortality of patients. The risk factors for developing AKI after leptospira infection include systemic and renal hemodynamic changes secondary to impaired renal function. Aims of the study were to evaluate the clinical features, biochemical parameters and outcomes of leptospira-associated acute kidney injury (AKI) according to the Acute Kidney Injury Network (AKIN) classification and to identify the predictors of mortality in affected patients. This observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh for one year. A total of 31 patients with acute leptospiral infection were enrolled in the study. Clinical examinations, laboratory investigations, management and outcomes of the patients were recorded in a structured case record form. These patients are divided according to the AKIN classification. After the collection of data, statistical analysis of the results was carried out. Out of 31 patients, the majority (58.1%) was between 31-50 years of age, with a mean age of 46.5±17.2 years (range 17-87). Males predominated (83.9%), with a male-to-female ratio of 5.2:1. Among the patients with AKI, 6(19.4%) required hemodialysis, 3(9.7%) died and 28(90.3%) recovered. Notably, maximum non-survivors were classified as AKIN stage 3. Univariate regression analysis demonstrated that Pulmonary edema (p=0.01), shock (p=0.01) emerged as significant predictors of mortality. Tachycardia (p=0.05) was also associated with higher odds of death were associated with mortality. There was a strong association between AKIN classification and patient outcome, with AKIN stage 3 predicting the highest mortality. Early recognition and timely initiation of dialysis in patients with AKIN stage 3 may improve survival. The early detection of AKI caused by severe leptospira infection is important to reduce associated morbidity and mortality. In first health care settings, the utilize of serum markers such as serum creatinine measurement continues to be very important. The AKIN stages are used to clarify the severity of patients.