Virchows Archiv

, Volume 456, Issue 4, pp 367–375

Acute kidney injury in human leptospirosis: an immunohistochemical study with pathophysiological correlation

Authors

  • Eduardo Rocha Araujo
    • Instituto de Medicina Tropical de S.Paulo
    • Department of PathologyS. Paulo University Medical School
  • Antonio Carlos Seguro
    • Renal Disease Basic Research Laboratory-LIM 12-“Hospital das Clinicas”University of S. Paulo Medical School
  • Anne Spichler
    • Renal Disease Basic Research Laboratory-LIM 12-“Hospital das Clinicas”University of S. Paulo Medical School
  • Antonio J. Magaldi
    • Renal Disease Basic Research Laboratory-LIM 12-“Hospital das Clinicas”University of S. Paulo Medical School
  • Rildo A. Volpini
    • Renal Disease Basic Research Laboratory-LIM 12-“Hospital das Clinicas”University of S. Paulo Medical School
    • Instituto de Medicina Tropical de S.Paulo
    • Department of PathologyS. Paulo University Medical School
Original Article

DOI: 10.1007/s00428-010-0894-8

Cite this article as:
Araujo, E.R., Seguro, A.C., Spichler, A. et al. Virchows Arch (2010) 456: 367. doi:10.1007/s00428-010-0894-8

Abstract

Tubulointerstitial nephritis is a common clinicopathological finding in leptospirosis. Clinically, nonoliguric acute kidney injury (AKI), hypokalemia, sodium, and magnesium wasting frequently occur in leptospirosis. The exact mechanisms of renal involvement remain largely unclear. Immunohistochemistry to detect expression of the endogenous sodium/hydrogen exchanger isoform 3 (NHE 3), aquaporin 1 and 2, α-Na+K+ATPase, and sodium–potassium–chloride cotransporter in its NKCC2 isoform was performed on kidneys removed during autopsy of human leptospirosis cases and kidneys removed during autopsy of human non-leptospirosis cases with and without evidence of acute tubular necrosis (ATN). A decrease in NHE 3, aquaporin 1, and α-Na+K+ATPase expression occurred in proximal convoluted tubule cells. Expression of aquaporin 1 was preserved along the descending thin limb of the loop of Henle in the outer medulla. α-Na+K+ATpase expression was essentially preserved in the distal tubules, i.e., the thick ascending limb of the loop of Henle, macula densa, and distal convoluted tubule. Aquaporin 2 expression in the collecting tubules was enhanced compared to those of non-leptospirotic kidneys. NKCC2 cotransport isoform was expressed in the thick ascending limb of the loop of Henle and was essentially preserved in leptospirotic kidneys. Primary injury of the proximal convoluted tubules is regarded as the hallmark of the kidney in leptospirosis. Sodium and water transport are particularly affected with increased distal potassium excretion, hypokalemia, and polyuria. Enhanced expression of aquaporin 2 in medullary collecting tubules is probably an attempt to retain water during the nonoliguric phase of renal failure.

Keywords

LeptospirosisHumanKidneyImmunohistochemistry

Copyright information

© Springer-Verlag 2010