Kidney injury in children and adolescents with leptospirosis in France

Résumé 0

IntroductionLeptospirosis is an anthropozoonosis with polymorphic clinical symptoms and highly variable severity, ranging from flu-like symptoms to severe acute kidney injury. This disease has a high incidence in tropical regions, but there is a trend toward increasing incidence in metropolitan France and on Réunion Island. The objective of this study was to describe the epidemiological, clinical, laboratory, and therapeutic characteristics of pediatric leptospirosis in metropolitan France and on Réunion Island.Patients and methodsWe performed a retrospective analysis of patients admitted to hospital for leptospirosis in university hospitals employing members of the Société de néphrologie pédiatrique (French Pediatric Nephrology Society, SNP) in France between January 2008 and December 2020. In total, 6 centers reported leptospirosis cases, 1 center had been consulted by such a patient but was unable to provide sufficient data, and 10 centers did not identify any cases.ResultsA total of 21 cases were reported (mean age 13.4±3.4 years), mostly in male patients (male/female ratio 6:1). Of these 21 patients, 95% had had fever, 71% myalgia, 81% thrombocytopenia, and 76% gastrointestinal symptoms. Regarding renal impairment, 18 patients (86%) had had acute kidney injury, including 4 (19%) with oliguria, but none of them had required acute dialysis. About 30% of patients had had laboratory markers of tubulopathy, such as hypophosphatemia, hypokalemia, or tubular proteinuria. No deaths caused by the disease were reported. Therapeutic management followed the current guidelines, consisting of antibiotic therapy with amoxicillin or third-generation cephalosporins with symptomatic treatment. Where post-discharge laboratory results were available, creatinine levels had decreased.DiscussionIn this multicenter retrospective study, we report 21 cases of leptospirosis in children and adolescents, with a significant proportion of acute kidney injury, and favorable outcome. Children and adolescents do not seem to be at high risk of chronic kidney disease progression, but nephrology follow-up was not systematically carried out. Compared to studies performed in adults, the prognosis was better and hepatic impairment was rare. Compared to other pediatric studies, conjunctivitis was not a common symptom, but kidney injury and survival appeared to be similar. Children and adolescents presented with anicteric renal symptoms. The case review was not exhaustive and did not include France’s other overseas territories, which account for the highest proportion of leptospirosis infections.ConclusionLeptospirosis is an infection that can lead to multiorgan failure, with kidney involvement conditioning the outcome. Despite a better prognosis in children and adolescents, it remains important to diagnose this infection quickly in order to start appropriate antibiotic therapy and monitor kidney function.