Acute Kidney Injury Associated with Leptospirosis and/or COVID-19 Pneumonia

ABSTRACT

Aim and objectives: To compare the mortality and outcome of patients with acute kidney injury (AKI) associated with leptospirosis and/or COVID-19 pneumonia. Materials and methods: The study was conducted by the Department of Nephrology in a tertiary care setup with 97 patients with acute kidney injury over a period of 3 months from July 2020 to September 2020. All the patients were divided into 3 main categories 1. Leptospirosis with AKI. 2. COVID-19 pneumonia with AKI and 3. Patients having both leptospirosis and COVID-19 pneumonia with AKI. AKI was defined and staging was done as per KDIGO guidelines. Need for renal replacement therapy as well mechanical ventilation was noted. Thereby, the outcome and mortality were compared among the three groups. Results: Out of 97 patients included in the study, 57 (53.6%) patients had leptospirosis with AKI (group I), 25 (25.8%) patients had COVID-19 pneumonia with AKI (group II), whereas 20 (20.6%) patients suffered from leptospirosis and COVID-19 pneumonia with AKI (group III). There was a statistically significant difference between mortality rates in patients with leptospirosis, COVID, and both infections (χ2 = 6.210, p = 0.045). The mortality rate was 25% in leptospirosis patients and 52% in patients with COVID. This difference was statistically significant (p = 0.019). The mortality rate among patients with both leptospirosis and COVID was 45%. 15.4% of patients of group I required renal replacement therapy (RRT) in comparison to 16% of patients of group II and 35% of patients of group III. There was no statistically significant difference noted between the 3 groups (p value = 0.149). Mechanical ventilation requirement Group I - 14/52 patients (26.9%). Group II - 7/25 (28%). Group III - 13/20 (65%). There was a significant difference in the number of patients requiring mechanical ventilation among the three groups (χ2 = 9.930, p = 0.007) with group III requiring the highest. Conclusion: AKI in patients with dual infection with leptospirosis and COVID-19 results in an increased need for mechanical ventilation without a concomitant increase in the need for RRT. Despite this, the mortality remains the highest in patients with COVID-19 and AKI as compared to those with dual infection and AKI.