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Abstract
Leptospirosis is the most prevalent zoonosis affecting more than 1 million populations
worldwide. Interestingly, leptospirosis endemic regions coincide with chronic kidney
disease (CKD) hotspots largely due to flooding and agricultural overlaps. Acute leptospirosis
induces multiple organ dysfunction including acute kidney injury and may predispose
to CKD and end-stage renal disease, if not treated timely. Asymptomatic infection
may carry the bacteria in the kidney and CKD progresses insidiously. Histologic finding
of leptospirosis renal disease includes tubulointerstitial nephritis, interstitial
fibrosis, and tubular atrophy. Proximal tubule dysfunction and hypokalemia are observed
in adult male workers with leptospirosis, a characteristic similarity to CKD unknown
etiology (CKDu). CKDu is a form of CKD that is not attributable to traditional risk
factors clustering in agricultural communities affecting young male farmers. Kidney
pathology shows a chronic tubulointerstitial disease. CKDu is being reported as an
endemic nephropathy across the globe. Recent surveys suggest that asymptomatic leptospira
renal colonization is an overlooked risk for renal fibrosis and CKDu. Population with
anti-leptospira seropositivity is associated with lower estimated glomerular filtration
rate in endemic regions and carrier may progress to CKD. Leptospirosis has been considered
as a risk factor for CKDu in Sri Lanka and in Mesoamerican area. Sugarcane workers
in Nicaragua showed increased anti-leptospira seropositivity and higher urinary biomarkers
for kidney injury. Emerging evidence with signs of infection were reported in these
endemic population, indicating that leptospira exposure could play a role in CKDu
as a cause of primary kidney disease or a susceptible factor when secondary injury
such as heat stress or dehydration aggravates kidney disease. Therefore, leptospirosis
as an emerging culprit of CKDu deserves further in-depth investigation.