Which of the following is a reported poor prognostic indicator for leptospirosis?

• A. Azotemia
• B. Hypercalcemia
• C. Hypophosphatemia
• D. Eosinophilia

Answer: (A)

Leptospirosis prognosis is heavily influenced by organ involvement, with kidney injury being a major determinant of outcome. Azotemia reflects acute kidney injury from the infection, shown by rising BUN and creatinine, and it correlates with higher mortality and a greater need for intensive care or dialysis. This renal impairment disrupts waste clearance, fluid balance, and electrolyte regulation, so its presence signals a more severe disease course. The other abnormalities—hypercalcemia, hypophosphatemia, and eosinophilia—aren’t typical indicators of severe leptospirosis, so they don’t carry the same prognostic weight. Recognizing azotemia guides urgent supportive care, careful fluid management, and consideration of renal replacement therapy if needed.