Leptospirosis and the Kidney

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Leptospirosis, the most prevalent zoonotic disease globally, affects over 1 million individuals each year, with the kidney being the primary site of colonization for Leptospira during systemic infection. This occurs mainly in the interstitium and renal tubule epithelial cells. In cases of acute kidney injury (AKI), the key histological findings include acute tubulo-interstitial nephritis and acute tubular necrosis, often presenting with hypokalemia and non-oliguria. The damage from Leptospira's outer membrane protein components activates innate immunity pathways, including Toll-like receptors and complement cascades, leading to extracellular matrix accumulation as the infection progresses to chronic kidney disease (CKD). Recent research suggests that leptospira may induce CKD in humans through either an AKI-CKD continuum or subclinical infections. This highlights leptospirosis kidney disease as a newly recognized area that demands urgent medical and public health focus. This publication features contributions from leading experts, offering insights into the clinical and research aspects of leptospirosis kidney disease. It emphasizes the significant kidney injury caused by this often underestimated infection, providing valuable information and perspectives for future research in this field.