Leptospirosis with Crescentic Glomerulonephritis
AbstractInfection associated glomerulonephritis is well recognized. A 30-year-old man presented with fever, vomiting and oliguria for two weeks. He had a blood pressure of 150/105 mmHg and mild pedal oedema. Initial investigations revealed serum creatinine 921 µmol/l, with microscopic haematuria and proteinuria. Serum C3 levels were reduced. Renal histopathology revealed diffuse mesangial proliferation and neutrophilic exudation, as well as cellular crescents. IgG and C3 were seen on immunofluorescence. Leptospira IgM antibody titres were elevated. Myocarditis also developed during hospital admission. He was managed with cefoperazone/ sulbactam, azithromycin and intermittent haemodialysis. Intravenous methylprednisolone was started on seventh day for three doses. The patient responded to antibiotics, with complete recovery of renal/ cardiac functions and resolution of proteinuria. He has remained well over the last seven months. Leptospirosis is usually associated with tubulo-interstitial disease. This case is unique because crescentic glomerulonephritis has not been described in association with leptospirosis before.
Keywords:Acute kidney injury, complement C3, glomerulonephritis, rapidly progressive glomerulonephritis
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