INTRODUCTION: leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil. METHODS: this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800). RESULTS: a total of 201 patients were included, with mean age of 38.9 ± 15.7 years; 79.1% were male. The mean length from onset of symptoms to admission was 7 ± 3 days. The main clinical signs and symptoms at admission were fever (96.5%), jaundice (94.5%), myalgia (92.5%), headache (74.6%), vomiting (71.6%) and dehydration (63.5%). Hemorrhagic manifestations were present in 35.8%. Acute kidney injury was found in 87% of the patients. Platelet count was less than 100,000/mm³ in 74.3%. Hematuria was found in 42.9%. Death occurred in 31 cases (15.4%). CONCLUSIONS: leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients.

Visceral leishmaniasis is an endemic disease caused by various species of Leishmania. We made a retrospective study of 57 consecutive patients with visceral leishmaniasis in Brazil. Patients with visceral leishmaniasis were identified using the registries of the São José Infectious Diseases Hospital. The sample was divided into two groups: patients with serum creatinine (Scr) <1.3mg/dL and Scr > 1.3mg/dL. We compared these two groups for differences in clinical manifestations and laboratory features. Patients' mean age was 28 ± 18 years old; 74% were male. The main clinical symptoms and signs presented in the initial evaluation were: fever (97%), splenomegaly (96.4%), weight loss (95.5%), pallor (93.6%), cough (89.7%), hepatomegaly (87.2%), asthenia (83.3%), anorexia (82.9%) and vomiting (73.9%). Acute renal failure was found in 15 patients (26.3%) and eight of these patients had ARF before amphotericin B administration. The mean age was higher in the group with Scr > 1.3mg/dL. Death occurred in three cases; all deaths occurred with Scr > 1.3mg/dL. There were no significant differences in the frequencies of the clinical symptoms and signs between the two groups. The laboratory data and demographic characteristics were significantly worse in the Scr > 1.3mg/dL group. Renal dysfunction is an important feature of this disease; it is associated with important morbidity and can increase mortality.

La enfermedad de Behcet (EB) está asociada a daño renal en cerca de un tercio de los casos y una variedad de lesiones renales han sido descritas. Un hombre de 27 años presentaba historia de ulceraciones orales y genitales, en asociación con pseudofoliculitis y artritis en su rodilla izquierda. Los primeros exámenes evidenciaban urea = 53mg/dL, creatinina = 1,8mg/dL. El análisis de orina presentaba leucocituria. El tratamiento inicial fue ceftriaxone, talidomida y prednisona. El enfermo se quedó clínicamente estable, con función renal normal, pero presentando hematuria y proteinuria. Pasado un año, su orina resultó oscura. Nuevos exámenes mostraban urea = 58mg/dL, creatinina = 1,4mg/dL y proteinuria (500-1000mg/día). Dos años después la proteinuria aumentó para 2230mg/día. La biopsia renal mostraba uno glomérulo con esclerosis severa, atrofia tubular blanda, fibrosis intersticial blanda y espesamiento de las paredes arteriales. Tratamiento con captopril fue iniciado para reducir la proteinuria. Dos años después el paciente presentaba creatinina = 1,7mg/dL y proteinuria = 2509mg/día. Una nueva biopsia renal fue realizada e identificó glomerulonefritis creciente proliferativa, con depósitos granulares de IgA, IgM y C3. Fue ministrada pulsoterapia con metilprednisolone, ciclofosfamida endovenosa mensal y prednisone de manutención. El paciente se quedó estable, con creatinina de 1,3mg/dL y proteinuria de 500mg/día. La EB puede ser una de las muchas causas de nefritis secundaria por IgA. Es importante realizar periódicamente exámenes de función renal en los pacientes con EB, a través del análisis de orina y medidas de creatinina sérica y su clearance, para se detectar cualquier anormalidad y providenciar un tratamiento precoz.

Behcet’s disease (BD) is associated with renal involvement in about one-third of the cases and a variety of renal lesions have been reported. A 27-year-old man presented a history of recurrent oral and genital ulcers, associated with pseudofoliculitis and arthritis in his left knee. The first laboratory tests revealed: urea = 53mg/dL, creatinine = 1.8mg/dL. The urinalysis showed leukocyturia. Initial treatment with ceftriaxone, thalidomide and prednisone was instituted. He became clinically stable, with normal renal function, but presenting hematuria and proteinuria. One year later the patient presented dark urine. The new laboratory tests showed urea = 58mg/dL, creatinine = 1.4mg/dL, and mild proteinuria (500-1000mg/24h). Two years later the proteinuria was 2230mg/day. The renal biopsy showed one glomerulus with severe glomerular sclerosis, mild tubular atrophy, mild interstitial fibrosis and thickening of arterial walls. Treatment with captopril was started to decrease proteinuria. Two years later, the patient presented creatinine = 1.7mg/dL and proteinuria = 2509mg/day. A new renal biopsy evidenced proliferative crescentic glomerulonephritis, with diffuse granullary deposits of IgA, IgM and C3. It was instituted pulsotherapy with metilprednisolone, monthly endovenous cyclophosphamide and maintenance prednisone. The patient became clinically stable, with creatinine of 1.3mg/dL and proteinuria of 500mg/day. BD could be one of the various causes of secondary IgA nephritis. It is important to periodically perform renal function evaluation in patients with BD, through urinalysis and measurement of serum creatinine and its clearance, in order to detect any abnormality and provide an early adequate treatment.