Acute kidney injury and thrombocytopenic fever—consider the infrequent causes

Laboratory testing confirmed AKI associated with anemia, lymphocytopenia, and monocytosis as well as elevated CRP and LDH values (Table 2). Because the clinical presentation pointed to Hantavirus infection but urinalysis suggested acute glomerular dysfunction, a kidney biopsy was performed, revealing acute TIN and ATN. Based on small randomized trials, therapy for mild disease with penicillin or doxycyline shortens the duration of the illness and prevents shedding of the organisms. Because of high mortality of patients with severe leptospirosis, antiinfective therapy is recommended and should include doxycycline or a third-generation cephalosporin [21]. Because symptoms may be attributed to other diseases, a leptospiral infection may often remain undiagnosed. Because of its global importance, serologic testing for leptospirosis should be considered in any patient with nondistinctive AKI due to acute tubulointerstial nephritis and fever.