Grippe, meningitis, sepsis etc. are suspected in the early stage of leptospirosis icterohaemorrhagica and it is only in its icteric stage that epidemic hepatitis comes into question for differential diagnosis. Ten cases of leptospirosis ictero-haemorrhagica experienced by the authors from 1959 to 1963 demonstrated conspicuous differences from the other icteric diseases in haematology, erythorocyte sedimentation rate, renal disorder etc., and the prognosis of the former seemed to be influenced by the grade of renal insufficiency. Therefor, investigations were carried ut by the authors with great concern for the renal damage and the results were as follows:
1. Leptospirosis ictero-haemorrhagica shows a marked renal impairment.
Especially, in the early stage, glomerular filtration rate, renal blood flow and renal plasma flow are considerably lowered, and retarded excretion of P.S.P, uremia and proteinuria are also observed. These are important diagnostic criteria.
2. During the later half of the 1st to the early half of the 2nd week, diuresis usually -occurs and renal functions are improved within a relatively short time.
3. As a criterion for prognosis, improvement of renal function, i.e. diuresis is important.
4. Epidemic hepatitis, which must be differentiated from the disease, usually demonstrates only a slight renal impairment. Leptospirosis ictero-haemorrhagica belongs undoubtedly to the category of hepatorenal syndrome.
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