Dynamic Renal Deterioration in Flood-Associated Severe Leptospiral Multiorgan Dysfunction

2026-02-26T05:11:47+00:00

Severe leptospirosis remains an under-recognized cause of rapidly progressive multiorgan dysfunction in tropical, flood-prone regions, where delayed risk stratification contributes to preventable renal failure and mortality. Acute kidney injury (AKI) represents a pivotal determinant of outcome, yet its clinical trajectory may be dynamic and misleading. This case report aimed to characterize the temporal clinical and biochemical progression of severe leptospiral infection complicated by Stage 3 AKI and to identify practical implications for early bedside recognition in endemic settings. We conducted a retrospective case report in accordance with CARE guidelines. Clinical, epidemiological, laboratory, and radiological data were systematically extracted from hospital records. Diagnosis was established based on compatible clinical manifestations, documented floodwater exposure with skin barrier disruption, positive serology, structured scoring using Modified Faine’s Criteria, and AKI staging according to KDIGO guidelines. Serial laboratory monitoring enabled assessment of organ involvement and disease evolution. The patient developed cholestatic jaundice, thrombocytopenia, pulmonary inflammatory changes, profound electrolyte imbalance, and rapidly progressive renal dysfunction fulfilling KDIGO Stage 3 criteria. Notably, transient improvement in serum creatinine preceded abrupt deterioration requiring hemodialysis, underscoring the non-linear course of leptospiral AKI. Integrated supportive management and tailored antimicrobial therapy resulted in subsequent stabilization. This report highlights the need for dynamic renal monitoring and early escalation strategies in high-risk patients with environmental exposure. Incorporating structured diagnostic scoring and continuous biochemical surveillance into frontline care may improve prognostic accuracy and reduce severe renal complications in climate-vulnerable populations.

Comparison of LI-RADS Scores Before and After Transarterial Chemoembolization (TACE) in Hepatocellular Carcinoma Patients

2026-02-13T07:15:31+00:00

Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy, notorious for its elevated mortality. In intermediate-stage HCC where surgical resection is contraindicated, transarterial chemoembolization (TACE) is the primary treatment modality. Accurate evaluation of therapeutic response is essential to guide ongoing patient management. The Liver Imaging Reporting and Data System (LI-RADS), particularly its Treatment Response (LI-RADS TR) criteria, provides a validated radiographic method for assessing lesions before and after locoregional interventions. This study compared LI-RADS scores before and after TACE in patients at Dr. Soetomo Regional General Hospital, Surabaya. A retrospective observational design was employed, involving 37 HCC patients who underwent TACE and abdominal CT between January 2024 and July 2025. Statistical analysis used the paired t-test or Wilcoxon test (p < 0.05). The majority of patients were male (67.6%) with a mean age of 55.3 years. Before TACE, the most common categories were LR-5 (51.4%) and LR-4 (48.6%). Following TACE, 78.4% of tumors were classified as viable and 21.6% as non-viable by LI-RADS TR. No significant difference in tumor size was observed, but tumor-to-liver ratio was significantly reduced (p < 0.001). No significant association was identified between pre-TACE LI-RADS characteristics and post-TACE LI-RADS TR categories, except for the pre-treatment tumor-to-liver ratio. TACE significantly reduced the tumor-to-liver ratio; however, most lesions remained viable by LI-RADS TR. LI-RADS and LI-RADS TR are important tools for evaluating treatment response and guiding further management in HCC patients.

PHARMACOLOGY, MEDICAL REPORTS, ORTHOPEDIC, AND ILLNESS DETAILS

Dynamic Renal Deterioration in Flood-Associated Severe Leptospiral Multiorgan Dysfunction

Comparison of LI-RADS Scores Before and After Transarterial Chemoembolization (TACE) in Hepatocellular Carcinoma Patients