BÁO CÁO CA LÂM SÀNG: ĐÁNH GIÁ CHỨC NĂNG THẬN Ở BỆNH NHÂN SUY GAN CẤP DO LEPTOSPIRA

Abstract

Introduction: Leptospirosis is a zoonotic infection that, upon transmission, activates an immune response which results in multi-organ dysfunction, including renal involvement. However, the accurate assessment of renal function in these patients is complicated when utilizing markers such as plasma creatinine and Cystatin C, as these parameters may be affected by inflammation or hepatic dysfunction. The objective of this study is to evaluate renal function in patients with a history of acute liver failure due to Leptospira infection, with a focus on the impact of inflammatory responses and hepatic dysfunction on renal biomarkers. Methods: Case report and retrospective literature review. Results: A 53-year-old male patient presented for follow-up 3 months after being diagnosed with acute liver failure due to Leptospira infection. The patient was subsequently diagnosed with chronic kidney disease. Plasma Cystatin C levels were elevated, and eGFR-cys was reduced; however, the patient did not exhibit overt clinical signs of renal failure. Plasma creatinine and eGFR-cre were within normal limits. The urinary microalbumin/creatinine ratio was also normal. Liver function tests showed mild elevation in liver enzymes, with total bilirubin and albumin levels remaining within normal ranges. Conclusion: Elevated cystatin C levels in the context of acute hepatitis may not accurately reflect renal impairment but may rather be a consequence of systemic inflammation. Furthermore, hepatic dysfunction may lead to a reduction in creatinine synthesis, resulting in a falsely elevated eGFR-cre. herefore, when encountering cases of acute hepatitis, particularly those caused by Leptospira, clinicians must exercise caution when relying solely on eGFR-cys to conclude renal failure. The integration of multiple indices or the use of a mixed eGFR formula is a crucial step to prevent overtreatment or misdiagnosis.