Favorable course of leptospirosis and hantavirus-induced acute tubulointerstitial nephritis under corticosteroid treatment

BackgroundWe present two children with acute tubulointerstitial nephritis (ATIN) caused by leptospirosis in a 12-year-old boy and hantavirus in a 10-year-old girl. The role of glucocorticoids in the management of ATIN triggered by infectious agents is unclear.Case-diagnosis/treatmentBoth children were hospitalized with jaundice, elevated serum creatinine, and thrombocytopenia. There was no oliguria or hypertension. Urine analysis revealed tubular proteinuria. Kidney biopsy was performed on one patient and showed tubulointerstitial inflammation with mild mesangial proliferation. Both patients were treated with glucocorticoids in view of deteriorating kidney function with respective serum creatinine values of 5.2 and 4.1 mg/dl. Both children exhibited an excellent clinical and biochemical response to treatment. Neither of the patients required dialysis. Positive serology test results indicated a recent leptospirosis and hantavirus infection.ConclusionsLeptospirosis and hantavirus associated ATIN share common clinical and biochemical features. Due to the low incidence in Europe these infectious causes of kidney dysfunction may be overlooked. Glucocorticoids may be considered in the management of ATIN.

Automated summary

This study reports two cases of acute tubulointerstitial nephritis (ATIN) in children, one caused by leptospirosis in a 12-year-old boy and the other caused by hantavirus in a 10-year-old girl. Both patients presented with jaundice, elevated serum creatinine, and thrombocytopenia, with urine analysis revealing tubular proteinuria. Kidney biopsy confirmed tubulointerstitial inflammation. Both children showed excellent clinical and biochemical response to glucocorticoid treatment.