Nursing Care for Patients with Leptospirosis and Acute Kidney Injury Requiring Hemodialysis: 2 Case Studies

Abstract

Leptospirosis is an infectious disease that can cause acute kidney injury (AKI), a critical condition affecting multiple organ systems and potentially requiring renal replacement therapy with hemodialysis. This comparative case study aimed to examine nursing care approaches for two patients with leptospirosis-associated AKI who underwent hemodialysis and were admitted to the intermediate medical care unit at Songkhla Hospital during 2023–2024. Data were collected from medical records, patient and family interviews, clinical observations, laboratory investigations, and treatment plans, and were analyzed using the nursing process framework. The findings revealed that both patients developed severe infection with AKI requiring hemodialysis. However, the second case presented with greater disease severity and clinical complexity, including respiratory failure, hyperkalemia, and severe metabolic acidosis, requiring intensive respiratory care and close monitoring of acid–base balance and electrolyte disturbances. In contrast, the first case showed better renal recovery and was able to discontinue hemodialysis before discharge. Nursing care in both cases emphasized continuous care throughout the critical phase, continuing care phase, and discharge planning phase. Rapid patient assessment, close monitoring for complications, and systematic nursing management played important roles in reducing complications and improving nursing outcomes.