PECULIAR ELECTROLYTIC AND HORMONAL ABNORMALITIES IN ACUTE-RENAL-FAILURE DUE TO LEPTOSPIROSIS

Hypokalemia in leptospirosis acute renal failure (ARF) was studied in nine patients with severe leptospirosis ARF and five patients with mod erate leptospirosis ARF and compared with five patients with severe ac ute tubular necrosis (ATN) and eight healthy individuals. Urinary volu mes of both the severe and moderate leptospirosis groups were higher t han those of the severe ATN group. Leptospirosis groups had serum pota ssium levels lower than those found in the healthy and severe ATN grou ps. Serum sodium levels were lower in the severe leptospirosis group t han in the moderate leptospirosis, the severe ATN, and the healthy gro ups. There was a positive correlation between the fractional excretion of sodium and potassium in the severe leptospirosis group as well as between serum creatinine and potassium levels in the pooled leptospiro sis groups. Urinary pH in the severe and moderate leptospirosis groups was lower than in the severe ATN group. Aldosterone levels were highe r in the severe leptospirosis group than in the healthy individuals. C ortisol levels were higher in the leptospirosis groups than in the hea lthy subjects. These results strongly suggest that hypokalemia in lept ospirosis ARF is due to renal potassium wasting potentialized by aldos terone and cortisol, requiring that special attention is given to pota ssium replacement as well as to volume repletion in the treatment of l eptospirosis ARF.