Urban leptospirosis case highlights severe non-oliguric AKI risk

A newly published case report in Veterinary Sciences spotlights a severe but clinically important presentation of canine leptospirosis: a three-year-old urban Border Collie in the Republic of Korea developed suspected leptospirosis-associated, non-oliguric IRIS grade V acute kidney injury after exposure to stagnant water, despite continuing to produce urine. The dog, which had not been vaccinated against leptospirosis, was treated with hemodialysis and supportive care and ultimately improved, underscoring that even extreme azotemia may be reversible with aggressive management. (academic.oup.com)

That framing matters because the older stereotype of leptospirosis as mainly a rural disease has been steadily eroding. The 2023 ACVIM consensus update says leptospirosis remains prevalent in dogs of different sizes, ages, and geographies, including small dogs from urban areas and dogs that are inadequately vaccinated. AAHA’s updated canine vaccination guidance now lists leptospirosis among core vaccines for dogs, while WSAVA’s 2024 guidelines say the vaccine should be considered core in regions where canine leptospirosis occurs, relevant serogroups are known, and suitable vaccines are available. (pubmed.ncbi.nlm.nih.gov)

The case itself appears to center on a classic exposure pathway with a less-classic renal presentation. According to the source summary, the dog presented with acute gastrointestinal signs and moderate dehydration after contact with urban stagnant water. Laboratory findings included blood urea nitrogen of 175.8 mg/dL, creatinine of 11.10 mg/dL, and phosphorus of 13.6 mg/dL, fitting IRIS grade V AKI. What stands out is that the patient was non-oliguric, a useful reminder that urine production alone can underestimate severity. IRIS guidance emphasizes grading AKI systematically, and its best-practice recommendations note that infectious causes, including leptospirosis, should be part of the workup in appropriate cases. (iris-kidney.com)

The report also aligns with broader literature on severe leptospirosis management. The ACVIM consensus notes that intermittent and continuous hemodialysis platforms have both been used successfully in dogs with leptospirosis, and that hospitalized cases should have at least daily biochemistry monitoring to track renal values, bilirubin, liver enzymes, proteins, electrolytes, and acid-base status. Older outcome data and newer retrospective work both suggest that dogs with severe azotemia can survive with dialysis support, although prognosis worsens with complications such as anuria, respiratory disease, disseminated intravascular coagulation, pancreatitis, and higher IRIS AKI grade. (academic.oup.com)

Industry and expert commentary around leptospirosis has also shifted toward urban risk and missed prevention opportunities. In a recent dvm360 Q&A, Jane Sykes said urban wildlife, social conditions, and vaccination gaps are reshaping where veterinarians encounter the disease, while also cautioning that leptospirosis diagnosis can be tricky and test interpretation can be confounded by prior exposure. That caution is consistent with published reports showing that confirmation may be difficult even in dogs with compatible renal and hepatic disease, and that convalescent titers may be needed when acute testing is negative. (dvm360.com)

Why it matters: For practicing veterinarians, this case is less about a single dog in Korea and more about pattern recognition. A dog with vomiting, diarrhea, marked azotemia, glucosuria, and a history of stagnant-water exposure can have fulminant leptospirosis even without oliguria. That has implications for triage, isolation and staff biosafety, client communication, and referral timing for extracorporeal support. It also supports more proactive vaccine discussions with pet parents in urban practice, especially as major guidance bodies have moved away from the idea that leptospirosis is mainly a niche, rural exposure. (academic.oup.com)

The prevention angle may be the most actionable takeaway. AAHA says any dog that goes outdoors can be exposed, and its guidance now treats leptospirosis vaccination as part of routine preventive planning for most dogs. WSAVA takes a region-based approach but still recommends broad use where the disease is present. For clinics, that means this case can serve as a concrete example when discussing risk with pet parents who assume city dogs are low-risk, or who decline vaccination because their dog doesn’t hike, hunt, or swim in rural areas. (aaha.org)

What to watch: Going forward, watch for more reports that separate non-oliguric from oliguric leptospirosis-associated AKI, wider use of standardized IRIS AKI grading in case reporting, and continued evolution in vaccination recommendations as urban exposure patterns and serogroup surveillance become clearer. (iris-kidney.com)