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Galvão RLDF, Meneses GC, Pinheiro MCC, Martins AMC, Daher EDF, Bezerra FSM. Kidney injury biomarkers and parasitic loads of Schistosoma mansoni in a highly endemic area in northeastern Brazil. Acta Trop 2022; 228:106311. [PMID: 35038425 DOI: 10.1016/j.actatropica.2022.106311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 01/20/2023]
Abstract
Schistosomiasis affects approximately 240 million people worldwide. In Brazil, it is estimated that 1.5 million people are infected with Schistosoma mansoni and up to 15% of diagnosed individuals develop kidney damage. Renal involvement in schistosomiasis mansoni is characterized by glomerular lesions, with a high incidence, especially in chronically infected patients living in areas of high endemicity. Renal damage occurs slowly and is often asymptomatic, with a long-term manifestation of chronic kidney disease, with progressive loss of kidney functions, and early detection of subclinical kidney disease is of great importance. The aim of this study was to investigate kidney damage in patients infected with S. mansoni through urinary biomarkers of kidney injury and their association with the different parasite loads found. The patients were divided into two groups based on the diagnosis of infection by S. mansoni by the Kato-Katz and IgG-ELISA-SEA method: group of individuals infected by S. mansoni, Kato-Katz positive (PG); and group of individuals not infected by S. mansoni, Kato-Katz-negative (NG). Urinary creatinine and albuminuria were determined by immunoturbidimetry and proteinuria by the colorimetric method. The urinary biomarkers of podocyte injury (VEGF and Nephrin) and glomerular inflammation (MCP-1) were quantified by immunoassay and expressed by the urinary creatinine ratio. Urinary VEGF showed significantly higher levels in PG compared to NG (p = 0.004), increasing at all intensities of infection including low parasite load (p = 0.020). Our results show increased signs of podocyte damage in patients with schistosomiasis mansoni regardless of the parasite load, evidenced by increased urinary VEGF levels. However, further studies are needed since data related to schistosomiasis glomerulopathy and its association with new urinary biomarkers of kidney injury are scarce in the literature.
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Liao ZN, Tao LJ, Yin HL, Xiao XC, Lei MX, Peng ZZ. Schistosoma japonicum infection associated with membranous nephropathy: a case report. BMC Infect Dis 2022; 22:125. [PMID: 35123391 PMCID: PMC8818173 DOI: 10.1186/s12879-022-07092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Schistosomiasis is one of the most contagious parasitic diseases affecting humans; however, glomerular injury is a rare complication mainly described with Schistosoma mansoni infection. We report a case of membranous nephropathy associated with Schistosoma japonicum infection in a Chinese man. Case presentation A 51-year-old Chinese male with a long history of S. japonicum infection presented to the hospital with a slowly progressing severe lower limb edema and foaming urine for over 5 months. Serum S. japonicumantigen test was positive and immunohistochemistry showed that the glomeruli were positive for the antigens. The renal pathologic diagnosis was stage III membranous nephropathy. The patient was treated with glucocorticoid, praziquantel, and an angiotensin-converting enzyme inhibitor. The edema in both lower limbs disappeared within 2 weeks, but his renal function declined progressively and proteinuria persisted after 5 months of therapy. Conclusions Different classes of schistosomal glomerulopathy have completely different clinical manifestation and prognosis. Therefore, efforts should focus on alleviating symptoms, prevention, and early detection. S. japonicumassociated with membranous nephropathy may show a good curative effect and prognosis. However, it is necessary to monitor the renal function in such patients.
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Araújo SDA, Neves PDMDM, Wanderley DC, Reis MAD, Dias CB, Malheiros DMAC, Onuchic LF. The immunohistological profile of membranous nephropathy associated with chronic Schistosoma mansoni infection reveals a glomerulopathy with primary features. Kidney Int 2020; 96:793-794. [PMID: 31445585 DOI: 10.1016/j.kint.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Stanley de Almeida Araújo
- Centro de Microscopia Eletrônica, Federal University of Minas Gerais, BeloHorizonte, Brazil; Instituto de Nefropatologia, Belo Horizonte, Minas Gerais State, Brazil.
| | | | - David Campos Wanderley
- Centro de Microscopia Eletrônica, Federal University of Minas Gerais, BeloHorizonte, Brazil; Instituto de Nefropatologia, Belo Horizonte, Minas Gerais State, Brazil
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Alkhamees MA. Bladder stones in a closed diverticulum caused by Schistosoma mansoni: A case report. World J Clin Cases 2020; 8:4475-4480. [PMID: 33083406 PMCID: PMC7559665 DOI: 10.12998/wjcc.v8.i19.4475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/30/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Genitourinary (GU) schistosomiasis is a chronic infection caused by a parasitic trematode, with Schistosoma haematobium (S. haematobium) being the prevalent species. The disease has a variable prevalence around the world, with a greater burden on, but not limited to Africa, South America, Asia, and the Middle East.
CASE SUMMARY We report the case of a 30-year-old man who presented with symptoms of bladder stones. During endoscopic cystolithalopaxy, we did not detect any stones in the bladder. Upon careful scanning of the urinary bladder trigone, sandy patches were detected. We performed endoscopic resection, which revealed a closed diverticulum with bladder stones. The diverticular wall was sent for histopathology and revealed features of chronic granulomatous inflammation with numerous embedded Schistosoma eggs, with some of the eggs having lateral spines. The patient was treated with praziquantel, and his symptoms completely resolved.
CONCLUSION GU schistosomiasis is primarily caused by S. haematobium. However, Schistosoma mansoni mediated GU schistosomiasis is unusual, making this a quite interesting case.
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Affiliation(s)
- Mohammad A Alkhamees
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah 15361, Saudi Arabia
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Worasith C, Wangboon C, Duenngai K, Kiatsopit N, Kopolrat K, Techasen A, Sithithaworn J, Khuntikeo N, Loilome W, Namwat N, Yongvanit P, Carlton EJ, Sithithaworn P. Comparing the performance of urine and copro-antigen detection in evaluating Opisthorchis viverrini infection in communities with different transmission levels in Northeast Thailand. PLoS Negl Trop Dis 2019; 13:e0007186. [PMID: 30735492 PMCID: PMC6383950 DOI: 10.1371/journal.pntd.0007186] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/21/2019] [Accepted: 01/23/2019] [Indexed: 11/19/2022] Open
Abstract
To combat and eventually eliminate the transmission of the liver fluke Opisthorchis viverrini, an accurate and practical diagnostic test is required. A recently established urine antigen detection test using monoclonal antibody-based enzyme-linked-immunosorbent assay (mAb-ELISA) has shown promise due to its high diagnostic accuracy and the use of urine in place of fecal samples. To further test the utility of this urine assay, we performed a cross sectional study of 1,043 people in 3 opisthorchiasis endemic communities in northeast Thailand by applying urine antigen detection together with copro-antigen detection methods. The quantitative formalin-ethyl acetate concentration technique (FECT) was concurrently performed as a reference method. The prevalence of O. viverrini determined by urine antigen detection correlated well with that by copro-antigen detection and both methods showed 10-15% higher prevalence than FECT. Within the fecal negative cases by FECT, 29% and 43% were positive by urine and copro-antigen detection, respectively. The prevalence and intensity profiles determined by antigen detection and FECT showed similar patterns of increasing trends of infection with age. The concentration of antigen measured in urine showed a positive relationship with the concentration of copro-antigen, both of which were positively correlated with fecal egg counts. The data observed in this study indicate that urine antigen detection had high diagnostic accuracy and was in concordance with copro-antigen detection. Due to the ease and noninvasiveness of sample collection, the urine assay has high potential for clinical diagnosis as well as population screening in the program for the control and elimination of opisthorchiasis.
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Affiliation(s)
- Chanika Worasith
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Chompunoot Wangboon
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | - Kunyarat Duenngai
- Department of Public Health, Faculty of Science and Technology, Phetchabun Rajabhat University, Phetchabun, Thailand
| | - Nadda Kiatsopit
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Kulthida Kopolrat
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Anchalee Techasen
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | | | - Narong Khuntikeo
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Watcharin Loilome
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nisana Namwat
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puangrat Yongvanit
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth J. Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz, Aurora, Colorado, United States of America
| | - Paiboon Sithithaworn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
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Glomerular Detection of Schistosomal Antigen by Immunoelectron Microscopy in Human Mansonian Schistosomiasis. Int J Surg Pathol 2016. [DOI: 10.1177/106689699900700404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schistosomal antigens (S. mansoni) were detected in glomeruli of nine patients with nephropathy and nephrotic syndrome by immunoelectron microscopy. The criteria for patients' selection were presence of intestinal schistosomiasis and absence of any surgical or other medical diseases, particularly lupus erythematosus, syphilis, and hepatitis B and C, which could explain the renal disease. When examined by light microscopy, kidney biopsies showed type I membranoproliferative glomerulonephritis in four patients, focal segmental glomerulosclerosis in two, and mesangioproliferative glomerulonephritis, membranous glomerulonephritis, and minimal change disease in one each of the remaining three patients. Immunofluorescence showed mainly immunoglobulin G (IgG), IgM, and different complement components (C3, Clq) deposits, particularly in the mesangial area, in eight patients. All patients had gold-labeled schistosomal antigen deposits in their glomeruli, chiefly in mesangial cells and matrix, along the glomerular membrane, and occasionally in the cytoplasm of epithelial cells. Although membranous glomerulonephritis has been rarely described in association with schistosomiasis and minimal change disease may be occasionally caused by an infectious disease like syphilis, the absence of definite experimental models and epidemiologic data suggests that coincidental pathologies without causal relationship with schistosomiasis cannot be ruled out to explain these findings.
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Blastocystis and Schistosomiasis Coinfection in a Patient with Chronic Kidney Disease. Case Rep Med 2014; 2014:676395. [PMID: 25389440 PMCID: PMC4217365 DOI: 10.1155/2014/676395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022] Open
Abstract
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) represent a spectrum of impaired immunity with effects on cellular immunity, soluble immune factors, and inflammation. As a result, infections due to impaired immune system responses are responsible for significant morbidity in patients with kidney disease. Because of immune dysfunction in CKD, these patients have reduced probability to clear infections and are susceptible to pathogenic effects of common organisms. We present a case of a patient with CKD coinfected with Schistosoma mansoni and Blastocystis spp. This appears to be the first reported association of Schistosoma mansoni and Blastocystis spp. in a patient with CKD.
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da Silva GB, Duarte DB, Barros EJG, De Francesco Daher E. Schistosomiasis-associated kidney disease: A review. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2013. [DOI: 10.1016/s2222-1808(13)60018-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Barsoum RS. Urinary schistosomiasis: review. J Adv Res 2012; 4:453-9. [PMID: 25685452 PMCID: PMC4293885 DOI: 10.1016/j.jare.2012.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/01/2012] [Accepted: 08/17/2012] [Indexed: 01/30/2023] Open
Abstract
In this review, the clinical manifestations of urinary schistosomiasis are displayed from a pathogenetic perspective. According to the prevailing host’s immune response profile, urinary schistosomiasis may be broadly categorized into cell-mediated and immune-complex-mediated disorders. The former, usually due to Schistosoma haematobium infection, are attributed to the formation of granulomata along the entire urinary tract. As they heal with excessive fibrosis, they may lead to strictures, calcifications and urodynamic abnormalities. The main impact is lower urinary, the site of heaviest ovi-position. Secondary bacterial or viral infection is common, any may be incriminated in secondary stone formation of the development of bladder malignancy. Immune-complex mediated lesions are usually associated with hepatosplenic schistosomiasis due to Schistosoma mansoni infection. Circulating complexes composed of schistosomal gut antigens and different classes of immunoglobulins deposit in the kidneys leading to several patterns of glomerular pathology. The latter have been categorized under six classes based on the histological and immunofluorescence profile. These classes have been linked to respective clinical manifestations and depend on the stage of evolution of the host’s immune response, extent of associated hepatic fibrosis and co-infection with salmonella or hepatitis C. Secondary amyloidosis develops in 15% of such patients, representing a critical impairment of macrophage function. Conclusion: The wide clinicopathological spectrum of urinary schistosomiasis mirrors the evolution of the host’s immune response according to chronicity of infection, bacterial or viral co-infection and, in the case of glomerulonephritis, to the extent of hepatic co-morbidity.
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Polito MG, de Moura LAR, Kirsztajn GM. An overview on frequency of renal biopsy diagnosis in Brazil: clinical and pathological patterns based on 9,617 native kidney biopsies. Nephrol Dial Transplant 2009; 25:490-6. [PMID: 19633091 DOI: 10.1093/ndt/gfp355] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies about the prevalence of renal and particularly glomerular diseases in Brazil are still scarce. METHODS We evaluated retrospectively the reports of 9,617 renal biopsies, analyzed by the same pathologist, from January 1993 to December 2007. RESULTS The 9,617 renal biopsies performed in subjects of all ages in native kidneys. 4,619 were primary glomerulopathies (GN), the most frequent was focal segmental glomerulosclerosis (FSGS, 24.6%), followed by membranous nephropathy (MN, 20.7%), IgA nephropathy (IgAN, 20.1%), minimal change disease (MCD, 15.5%), mesangioproliferative non IgAN (nonIgAN, 5.2%), diffuse proliferative GN (DPGN, 4.7%) and membranoproliferative GN (MPGN, 4.2%). Lupus nephritis was responsible for most cases which etiology was determined, i.e., 950 out of 2,046 cases (45.5%), followed by post infectious GN (18.9%), diabetic nephropathy (8.5%), benign and malignant nephroangiosclerosis (7.3%), haemolytic-uraemic syndrome and thrombotic thrombocytopenic purpura (HUS/TTP), amyloidosis (4.8%) and vasculitis (4.7%). There was a predominance of secondary GN in the North, mostly due to lupus nephritis (LN); FSGS was very common in Northeast (27.7%), Central (26.9%) and Southeast regions (24.1%); IgAN was most frequent in South (22.8%) and MN in North (29.6%); the total prevalence of MPGN was low, and its regional distribution has not changed along the years. CONCLUSION FSGS was the most frequent primary glomerular disease, followed closely by MN and IgAN. The predominance of FSGS is in accordance with recent studies all over the world that revealed its frequency is increasing. Lupus nephritis predominated among secondary GN in most regions, a finding observed in other studies.
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Affiliation(s)
- Maria Goretti Polito
- Glomerulopathy Section (Nephrology Division, Department of Medicine), Federal University of Sao Paulo, Brazil
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Ben Maïz H, Ben Moussa F, Goucha R, Abderrahim E, Kheder A. Glomérulonéphrites aiguës postinfectieuses. Nephrol Ther 2006; 2:93-105. [PMID: 16895721 DOI: 10.1016/j.nephro.2006.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hédi Ben Maïz
- Service de médecine interne A, laboratoire de recherche en pathologie rénale (Santé 02), hôpital Charles-Nicolle, boulevard du 9-Avril, 1006 BS Tunis, Tunisie.
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12
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Abstract
Brazil is one of the largest and most populous nations in the world, ranking among the 5 largest economies in the Americas and among the 15 largest economies in the world. However, Brazil is still plagued by social problems such as the persistence of poverty and immense deficiencies in its health system. Currently, there are approximately 390 patients on chronic renal replacement therapy (RRT) per million population, about one third the US prevalence, which suggests that end-stage renal disease is either underdiagnosed or undertreated. The epidemiology of renal disease in the small remaining native Brazilian population is largely unknown. However, it is likely that the prevalence of renal disease is low among at least 2 tribes: the Yanomamis in northern Brazil and the Xingu Indians in central Brazil. Sodium intake is very low, physical activity is intense, and the prevalence of hypertension and cardiovascular disease is negligible among these people, which stresses the potential pathogenic importance of so-called civilized habits. There is currently no conclusive evidence that African descendants or any other Brazilian ethnic minorities are especially vulnerable to renal disease. Access to RRT in Brazil is universal. However, because both the end-stage renal disease population and operational RRT costs are steadily increasing, the system may face severe limitations in the near future. Much effort is needed to limit the prevalence of renal disease, to detain or retard the progression of chronic nephropathies, and to ensure that high-quality RRT will remain available to all those who need it.
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Affiliation(s)
- Marília Bahiense Oliveira
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 3-s/3342, CEP: 01246-903 São Paulo, Brazil
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Ali-Khan Z, Li W, Chan SL. Animal model for the pathogenesis of reactive amyloidosis. ACTA ACUST UNITED AC 2005; 12:297-302. [PMID: 15275180 DOI: 10.1016/0169-4758(96)10032-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The pathogenesis of amyloidosis is not well understood. Here, Zafer Ali-Khan, Weihua Li and Sic L. Chan present a metazoan parasite mouse model of reactive amyloidosis, review the relationship between chronic inflammation and multiorgan AA amyloidosis and postulate how ubiquitin might function in the processing of serum amyloid A and in AA amyloid formation in the endosomes-lysosomes of activated murine reticuloendothetial cells.
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Affiliation(s)
- Z Ali-Khan
- Department of Microbiology and Immunology, McGill University, 3775 University Street, Montreal, Quebec, Canada.
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Abstract
Praziquantel (PZQ) is the safest of all anti-helminthics and now forms the backbone for all national control programs against schistosomiasis (Med. Res. Rev. 3 (1983) 147-200; Bull. WHO 57 (1979) 767-771; Wegner, D.H.G, Therapeutic Drugs (1991), Churchill Livingstone; Adv. Intern. Med. 32 (1987) 193-206; Drugs 42 (1991) 379-405; Pharmac. Ther. 68 (1995) 35-85; Ann. Intern. Med. 110 (1989) 290-296). Despite its lack of known toxicity, the drug was not tested on pregnant or lactating women prior to release. It is currently listed as Pregnancy Category B by the US FDA, which is a drug presumed safe based in animal studies. Unfortunately, this has been interpreted by most national control programs and WHO (1998) to exclude lactating and pregnant women from treatment. In fact, some experts advocate excluding adolescent girls from mass treatment campaigns over this issue. As a result, a large number of women living in endemic countries are currently left untreated or have treatment significantly delayed. A review of the current known toxicology of PZQ, combined with over two decades of clinical experience with this drug, suggest very low potential for adverse effects on either the mother or her unborn child. In contrast, significant animal and human data are presented in this review that suggest both the pregnant woman and her unborn fetus suffer morbid sequella from schistosomiasis. A double-blind placebo-controlled trial that could resolve this issue would require a very large and expensive study and in light of the above facts might not now be ethically appropriate. The author concludes that pregnant women should be treated with PZQ, that women of childbearing age should be included in all mass treatment programs and that lactating women are not systematically excluded from treatment.
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Affiliation(s)
- G Richard Olds
- Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Ave, Suite 4100, Milwaukee, WI 53226, USA.
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Zatz R, Romão JE, Noronha IL. Nephrology in Latin America, with special emphasis on Brazil. KIDNEY INTERNATIONAL. SUPPLEMENT 2003:S131-4. [PMID: 12864892 DOI: 10.1046/j.1523-1755.63.s83.28.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Latin America constitutes a complex universe that shows extreme variation regarding socioeconomic and human development. Brazil is the largest and most populous Latin American country, and combines characteristics encountered in developed countries with problems typically associated with the poorest regions of the world. These disparities condition the profile of renal disease in Brazil, with glomerulonephritis still the leading cause of ESRD. Little is known about the epidemiology of renal disease in the Brazilian (or Latin American) native population, which is numerous in some Central and South American countries, but constitute a very small minority in Brazil. However, interesting information has been obtained from the Yanomamis, a tribe living in Northern Brazil and Southern Venezuela. Hypertension is virtually absent among these people, who ingest very little sodium, lending strong support to the concept that sodium retention, a "civilization" factor, plays a role in the pathogenesis of arterial hypertension. Despite Brazil's striking socioeconomic disparities, access to RRT is in principle accessible to all those in need of it. The dialysis units have been modernized in recent years, whereas the Government covers most expenses related to RRT. However, the prevalence of RRT in Brazil is currently approximately 320 per million population, less than one third as high as in the US, suggesting that ESRD may be underdiagnosed in the country. Much effort is still needed to limit the prevalence of renal disease and to improve the quality and the reach of RRT in Brazil and in Latin America.
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Affiliation(s)
- Roberto Zatz
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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17
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Abstract
Renal diseases unique to the tropics are those that occur in association with infectious diseases including dengue hemorrhagic fever, typhoid fever, shigellosis, leptospirosis, lepromatous leprosy, malaria, opisthorchiasis, and schistosomiasis. These renal complications can be classified on the basis of their clinical and pathologic characteristics into acute transient reversible glomerulonephritis, chronic progressive irreversible glomerulonephritis, amyloidosis, and acute renal failure (ARF) resulting from acute tubular necrosis, acute tubulointerstitial nephritis, and thrombotic microangiopathy. Certain primary glomerular diseases including immunoglobulin (Ig) M nephropathy and focal segmental and global glomerulosclerosis are prevalent in some tropical countries. Renal complications of venomous snakebites also are common in the tropics. This article discusses and summarizes important works in the literature in respect to the clinical syndromes, pathologic features, and pathogenesis of tropical renal diseases both in humans and experimental animal models.
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Abstract
Although parasitic infections do not usually present with disturbance in renal function, glomerular lesions can be seen in most of these infections. The glomerular lesions observed in parasitic infections cover the whole range of glomerular lesions known, but most of them are proliferative. Little is known of the exact pathogenic mechanisms. In this review, we try to explain the glomerular lesions associated with parasitic infections in terms of the specific immunologic events observed during these diseases against the background of recent developments in the general knowledge of the pathogenesis of glomerular disease.
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van Velthuysen ML, Florquin S. Glomerulopathy associated with parasitic infections. Clin Microbiol Rev 2000; 13:55-66, table of contents. [PMID: 10627491 PMCID: PMC88933 DOI: 10.1128/cmr.13.1.55] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although parasitic infections do not usually present with disturbance in renal function, glomerular lesions can be seen in most of these infections. The glomerular lesions observed in parasitic infections cover the whole range of glomerular lesions known, but most of them are proliferative. Little is known of the exact pathogenic mechanisms. In this review, we try to explain the glomerular lesions associated with parasitic infections in terms of the specific immunologic events observed during these diseases against the background of recent developments in the general knowledge of the pathogenesis of glomerular disease.
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Affiliation(s)
- M L van Velthuysen
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Correia EI, Martinelli RP, Rocha H. [Is glomerulopathy due to schistosomiasis mansoni disappearing?]. Rev Soc Bras Med Trop 1997; 30:341-3. [PMID: 9265231 DOI: 10.1590/s0037-86821997000400012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hepatosplenic form of S. mansoni infection may be accompanied by a glomerulopathy in 12-15% of cases, manifested in the majority by a nephrotic. This type of renal involvement is becoming a rare occurrence in our University Hospital (Hospital Universitário Prof. Edgard Santos) a typical general hospital in an endemic state for this parasitic disease. To investigate this fact, autopsied cases with patients with hepatosplenic form of schistosomiasis mansoni during two decades in our Hospital-1960-70, (before a therapeutic intervention in endemic areas with oxamniquine) and 1980-1990 (after the intervention) were compared in reference to number of cases and the finding of glomerulonephritis by histological examination. Even though there was a striking decrease in number of patients with advanced forms of this disease (140 as compared to 31 autopsies in these two decades), the prevalence of glomerulonephritis diagnosed was 11.4 (16 cases) in the first and 12.9 (4 cases) in the second. As there was no change in pattern of attendance in this Hospital, the drastic decrease in number of severe forms of this parasitic infection following massive therapy of the endemic population with oxamniquine is the most likely explanation not only for the decrease in number of hepatosplenic cases but, also, and as a consequence, the scarcity of cases of the schistosomal glomerulopathy observed.
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Affiliation(s)
- E I Correia
- Departamento de Medicina, Universidade Federal da Bahia, Salvador, BA
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21
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Barsoum R, Nabil M, Saady G, Genin C, Saleh E, Francis M, el-Kalioubi A, Iskander I, el-Garem A. Immunoglobulin-A and the pathogenesis of schistosomal glomerulopathy. Kidney Int 1996; 50:920-8. [PMID: 8872967 DOI: 10.1038/ki.1996.392] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several observations suggest that the evolution of schistosomal glomerulopathy into clinically overt and progressive disease may involve pathogenetic mechanisms other than simple glomerular deposition of parasitic antigens. In a previous study, IgA was suggested to be a mediator of late glomerular lesions in this disease. This issue is further addressed in this work. The study includes 32 patients with hepatosplenic schistosomiasis, of whom 16 had overt glomerular involvement, along with four control groups: (a) 15 healthy volunteers; (b) 15 patients with simple intestinal mansoniasis; (c) 17 patients with non-schistosomal chronic liver disease; and (d) 21 subjects with primary nephrotic syndrome not associated with schistosomiasis. Routine assessment was done for all subjects including confirmatory tests for schistosomal infection, liver and renal function tests, hepatitis viral markers and abdominal ultrasonography. The total serum concentrations of IgG, IgM, IgA were measured, as well as their respective circulating immune complexes, rheumatoid factors, anti-gliadin- and anti-DNA-antibodies. Liver and renal biopsies were obtained from the relevant groups and studied by light microscopy. Renal biopsies were also examined by immunofluorescence. Patients with simple intestinal schistosomiasis had a significant increase in IgM antigliadin antibodies. Those complicated with hepatosplenic involvement also had a significant increase in the mean IgG anti-gliadin antibodies, IgG rheumatoid factor and IgM anti-DNA activity. Cases further complicated by overt glomerular disease showed a distinct IgA predominance, mainly expressed in the serum anti-gliadin antibody pool and anti-DNA activity. This profile was essentially similar to that observed in control cirrhotics. There was a significant increase in the frequency of IgA glomerular deposits in renal biopsies obtained from patients with overt schistosomal glomerulopathy, in contrast to control nephrotics. The deposits were mainly mesangial, but were also encountered in subendothelial, subepithelial and peritubular locations. Their frequency was significantly higher with more advanced lesions as seen by light microscopy. The relevance of these data is discussed, leading to the following conclusions: (a) serum IgA-anti-gliadin and -anti-DNA antibodies, and glomerular IgA deposits are markers of significant renal involvement in patients with hepatosplenic schistosomiasis. (b) IgA may be involved in the pathogenesis of advanced glomerular pathology when superimposed on parasite-induced lesions. (c) There is a significant increase in serum auto-reactivity in hepatosplenic schistosomiasis, which may also have pathogentic implications. (d) Increased production by the inflammatory bowel lesions, impaired clearance by the fibrotic livers and probable switching of immunoglobulin synthesis are suggested to explain the observed IgA predominance in those who develop renal complications.
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Abstract
Globally, schistosomes infect 1 in 30 people. Tourists travel to endemic areas, whereas students, workers, and expatriates travel to nonendemic areas. Physicians around the world need to remain aware of this common parasitic infection. Pathology results from parasite eggs that lodge in the intestines and liver. Intestinal schistosomiasis is most often asymptomatic and presents with occult gastrointestinal bleeding. Hepatosplenic schistosomiasis develops insidiously because of cumulative fibrotic injury. Stigmata of liver failure are absent unless comorbid viral or alcoholic hepatitis is present. Patients with end-stage hepatosplenic schistosomiasis die from variceal hemorrhage. Diagnosis of schistosomiasis is confirmed by finding eggs in stool or biopsy specimens. Antischistosome antibodies may identify infected tourists returning from endemic areas. Circulating schistosome antigens distinguish current from past infections. Praziquantel is the schistosomicidal drug of choice. Most cases of hepatosplenic schistosomiasis resolve after effective treatment. Prophylactic propranolol may prevent hemorrhage in praziquantel-treated patients with high-grade varices. Sclerotherapy is also efficacious. When necessary, patients with hepatosplenic schistosomiasis tolerate decompressive surgery well.
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Affiliation(s)
- D E Elliott
- Division of Gastroenterology, University of Iowa Hospitals and Clinics, Iowa City, USA
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23
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Abstract
Numerous infectious diseases, among them several parasitic infectious, have been shown to be associated with glomerular disease, although the exact pathogenetic mechanisms have not yet been elucidated. In this article, Marie-Louise van Velthuysen reviews the work published on glomerulopathy associated with the most important parasitic infections, ie. malaria, schistosomiasis, leishmaniasis and irypanosomiasis.
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Affiliation(s)
- M L Van Velthuysen
- Department of Pathology, University of Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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24
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Affiliation(s)
- H G Rennke
- Brigham and Women's Hospital, Boston, Massachusetts
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25
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Johansen MV, Simonsen PE, Butterworth AE, Ouma JH, Mbugua GG, Sturrock RF, Orinda DA, Christensen NO. A survey of Schistosoma mansoni induced kidney disease in children in an endemic area of Machakos District, Kenya. Acta Trop 1994; 58:21-8. [PMID: 7863851 DOI: 10.1016/0001-706x(94)90118-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The association between Schistosoma mansoni infection and kidney lesions was investigated in school children selected from three primary schools in Machakos District, Kenya, namely Miu (n = 159), Kitengei (n = 160) and Misuuni (n = 99) schools. The children were examined parasitologically for S. mansoni infection, clinically for enlargement of the liver and spleen, and biochemically for proteinuria and serum and urine creatinine. High prevalences of S. mansoni infection, ranging from 84-96%, were seen in all the schools, but the geometric mean intensity of egg excretion varied, being relatively low in Misuuni (31 eggs/g), medium in Miu (182 eggs/g) and high in Kitengei (413 eggs/g). The prevalence of pathological proteinuria (> or = 200 mg/l) in the schools ranged from 10.1% in Miu to 28.8% in Kitengei. No difference in the levels of proteinuria was noted between age or sex groups. No association between intensity of infection and pathological proteinuria was observed in any of the schools, nor was any correlation between organomegaly and proteinuria observed. However, significant correlations between malaria and organomegaly (p < 0.001) and between malaria and proteinuria (p < 0.05) were observed when pooling data from all schools. These findings suggest that S. mansoni induced nephrotic syndromes are not common in children from this highly endemic area of Kenya.
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26
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Rifai A. Immunopathogenesis of experimental IgA nephropathy. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1994; 16:81-95. [PMID: 7997949 DOI: 10.1007/bf00196716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A Rifai
- Department of Pathology, Brown University School of Medicine, Rhode Island Hospital, Providence 02903
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27
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Abensur H, Nussenzveig I, Saldanha LB, Pestalozzi MS, Barros MT, Marcondes M, Barros RT. Nephrotic syndrome associated with hepatointestinal schistosomiasis. Rev Inst Med Trop Sao Paulo 1992; 34:273-6. [PMID: 1342083 DOI: 10.1590/s0036-46651992000400002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (P < 0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membranoproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy.
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Affiliation(s)
- H Abensur
- Nephrology Division, Hospital das Clínicas, Faculty of Medicine, São Paulo University, Brazil
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29
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Casarosa L, Papini R, Mancianti F, Abramo F, Poli A. Renal involvement in mice experimentally infected with Toxocara canis embryonated eggs. Vet Parasitol 1992; 42:265-72. [PMID: 1496786 DOI: 10.1016/0304-4017(92)90068-k] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Histological examination of kidneys from mice experimentally infected with Toxocara canis embryonated eggs demonstrated the presence of a segmental or diffuse mesangioproliferative glomerulonephritis. Immunohistochemical studies established that renal alterations were associated with glomerular deposits of IgG, IgM and third component of complement (C3). These findings suggest that an immunomediated mechanism might possibly be involved in the genesis of kidney damage observed in mice infected with T. canis embryonated eggs.
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Affiliation(s)
- L Casarosa
- Dipartimento di Patologia Animale, Facoltà di Medicina Veterinaria, Università di Pisa, Italy
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30
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Martinelli R, Pereira LJ, Brito E, Rocha H. Renal involvement in prolonged Salmonella bacteremia: the role of schistosomal glomerulopathy. Rev Inst Med Trop Sao Paulo 1992; 34:193-8. [PMID: 1342069 DOI: 10.1590/s0036-46651992000300002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged Salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia.
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Affiliation(s)
- R Martinelli
- Departamento de Medicina, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brasil
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31
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Sobh MA, el Sharkawy SE, Shokeir AA, Moustafa FE, el Sherif AK, Ghoneim MA. Effects of schistosomiasis on living kidney donors. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1992; 26:409-12. [PMID: 1292081 DOI: 10.3109/00365599209181235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Twenty living kidney donors with schistosomiasis were compared with 20 uninfected donors for a mean follow-up period of 42 months (range 12-62). All patients with schistosomiasis had been treated preoperatively with antischistosomal chemotherapy. None of the donors developed any appreciable change in mean systolic or diastolic blood pressure during the follow-up period, though one infected and two uninfected donors had traces of protein in the urine. One uninfected donor developed microscopic haematuria. The two groups has similar reductions in renal function after unilateral nephrectomy. The response of the remaining kidneys to a combined infusion of dopamine and an amino acid preparation was similar in both groups. One infected and two uninfected donors were found to have developed mild hydroureter and hydronephrosis on excretory urography. Schistosomiasis did not significantly affect compensatory hypertrophy of the remaining kidney. We conclude that uncomplicated schistosomiasis in living kidney donors does not adversely affect either the function or the morphology of the remaining kidney, at least during an observation period of up to five years. Schistosomal infection does not seem to alter the adaptive changes in the remaining kidney, provided that the donor had functionally and morphologically intact kidneys and that the schistosomiasis was treated before kidney donation. Longer term evaluation is recommended, however, to confirm the validity of these observations.
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Affiliation(s)
- M A Sobh
- Urology and Nephrology Center, University of Mansoura, Egypt
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32
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Costa RS, Monteiro RC, Lehuen A, Joskowicz M, Noël LH, Droz D. Immune complex-mediated glomerulopathy in experimental Chagas' disease. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1991; 58:102-14. [PMID: 1824567 DOI: 10.1016/0090-1229(91)90152-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To investigate the development of glomerulopathy during the chronic phase of experimental Chagas' disease, C3H-Hej mice were infected with Trypanosoma cruzi trypomastigotes. Deposits of IgG, IgM, and C3 in renal mesangium were observed by immunofluorescence (IF) to increase in size as a function of time after infection (4-6 months). T. cruzi antigens were codeposited in glomeruli with Ig and C3. Electron-dense deposits were visualized in mesangial and paramesangial areas by electron microscopy. Anti-T. cruzi and rheumatoid factor (RF) antibodies (of IgG isotypes) were detected both in serum and in renal eluates. In serum, the titers of both antibodies progressively decreased as a function of time after infection. In renal eluates, titers of anti-T. cruzi antibodies appeared to be stable during the three time periods after infection. By contrast, titers of RF antibodies in renal eluates were shown to increase progressively during these same time periods, paralleling the increase in size of mesangial Ig deposits observed by IF. Several T. cruzi proteins were immunoprecipitated from radiolabeled renal eluates by a control anti-T. cruzi antibody. In addition, antibodies from renal eluates specifically precipitated a 85-kDa protein from radiolabeled T. cruzi lysates, whereas serum antibodies precipitated a broad pattern of T. cruzi proteins. These results demonstrate that mice experimentally infected with T. cruzi can develop a mesangial glomerulopathy during the chronic phase of the disease, which appears to be mediated through immune complexes containing parasite antigens associated with secondary deposition of RF.
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Affiliation(s)
- R S Costa
- INSERM U25, Hôpital Necker, Paris, France
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33
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Abstract
The common childhood renal disorders in Nigeria are post-infectious acute glomerulonephritis (PIAGN), nephrotic syndrome, hypertension, congenital anomalies and urinary tract infection. Children with PIAGN often present with hypertension, circulatory overload and hypoalbuminaemia. Nephrotic syndrome is characterized by a paucity of minimal change and a poor prognosis. Posterior urethral valves and hydronephrosis are the most frequent congenital anomalies. Children with congenital anomalies present late with advanced disease. The commonest malignancy is nephroblastoma, but Burkitt's lymphoma of the kidney also occurs. Both acute and chronic renal failure present depressing and distressing clinical problems, with an aggressive course and a high morbidity and mortality. Poor socio-economy has adverse effects on the presentation, management and follow-up of Nigerian children with renal disorders.
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Affiliation(s)
- M B Abdurrahman
- Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
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34
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Abdurrahman MB, Elidrissy AT, Shipkey FH, al Rasheed S, al Mugeiren M. Clinicopathological features of childhood nephrotic syndrome in Saudi Arabia. ANNALS OF TROPICAL PAEDIATRICS 1990; 10:125-32. [PMID: 1699474 DOI: 10.1080/02724936.1990.11747419] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The clinicopathological features are described in 119 Arab children in Saudi Arabia with the nephrotic syndrome. The clinical and laboratory data are similar to those described in other parts of the world. However, mesangial proliferative glomerulonephritis (MesPGN) was found in 21 of 66 biopsies (31.8%), giving a frequency of 17.6% of all children with the nephrotic syndrome. Minimal-change nephrotic syndrome (MCNS) was diagnosed in 17 biopsies (25.8%) and in 58 patients (48.7%). Onset of the nephrotic syndrome was at less than 1 year of age in 17 patients (14.3%). Seven children had 11 episodes of peritonitis. Seven children had positive hepatitis B surface antigen (HBsAg) in their serum: renal biopsy carried out on four of them showed membranous glomerulonephritis (MGN) in three, and four of the seven patients developed end-stage renal disease (ESRD). There were nine deaths, all in patients with end-stage renal disease: six of the deaths occurred in infants. The pattern of childhood nephrotic syndrome in Saudi Arabia is different from the pattern in tropical countries.
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Affiliation(s)
- M B Abdurrahman
- Department of Paediatrics, College of Medicine, Riyadh, Saudi Arabia
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35
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Sobh MA, Moustafa FE, Sally SM, Foda MA, Deelder AM, Ghoneim MA. A prospective, randomized therapeutic trial for schistosomal specific nephropathy. Kidney Int 1989; 36:904-7. [PMID: 2515342 DOI: 10.1038/ki.1989.278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this work 26 patients with schistosomal specific nephropathy were randomly distributed among three groups. Group I cases were given anti-schistosomal drugs (oxamniquine and praziquantel), group II cases were given anti-schistosomal drugs plus prednisolone, and group III cases were given anti-schistosomal drugs plus cyclosporine. The schistosomal specificity of kidney lesions was assessed by detecting the schistosomal specific antigens (CAA and CCA) and antibodies deposited in the renal glomeruli of these patients. Patients who had another etiologic cause which may explain their kidney disease were not admitted to this study. After initiation of the treatment, patients were followed up every other week in the outpatient clinic for 12 months. Follow-up showed complete remission of proteinuria in two cases in group II (duration of remission was 4 and 8 months) and in one case in group III (duration of remission was 6 months) but in none in group I. Partial remission was observed in one case in group I, in three cases in group II and in one case in group III. During the observation period, improvement in kidney function was observed in two cases in group II but deterioration in kidney function was observed in one case in group I and in one other case in group III. We conclude that in patients with schistosomal nephropathy, none of the tried therapeutic regimens produce regression of the disease if given to patients with established disease.
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Affiliation(s)
- M A Sobh
- Urology and Nephrology Center, University of Mansoura, Egypt
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36
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Abboud OL, Osman EM, Musa AR. The aetiology of chronic renal failure in adult Sudanese patients. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1989; 83:411-4. [PMID: 2604479 DOI: 10.1080/00034983.1989.11812365] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
One hundred adult Sudanese patients who presented to Soba University Hospital (SUH) with established chronic renal failure (CRF) were studied to determine the aetiology. Thirty-eight had chronic glomerulonephritis, 12 renal calculi, nine diabetic renal disease, seven chronic pyelonephritis, five sequelae of acute renal failure (ARF), four renal vascular disease, three polycystic disease of the kidneys, and two obstructive uropathy. In 20 patients the aetiology was not determined because of late presentation to hospital. The results were compared with those of the developed countries, which differ greatly from Sudan in climate, diet, race, culture and social habits. The main differences were in the prevalence of renal calculi which, although being the second commonest cause of CRF in the Sudan, were rare in European countries. Also, diabetes mellitus was a much commoner cause of CRF in Sudan than Europe. Other aetiological factors were similar.
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Affiliation(s)
- O L Abboud
- Department of Medicine, Faculty of Medicine, University of Khartoum, Sudan
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37
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Elsheikh M, Doehring-Schwerdtfeger E, Kaiser C, Abdelrahim IM, Ali GM, Franke D, Porrath K, Kardorff R, Ehrich JH. Renal function in Sudanese school children with Schistosoma mansoni infection. Pediatr Nephrol 1989; 3:259-64. [PMID: 2518450 DOI: 10.1007/bf00858526] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Renal function was investigated in 218 school children with Schistosoma mansoni infection in the Providence of Gezira in central Sudan and in 65 Sudanese and 65 German age-matched controls. Serum creatinine was normal in all children. A pathological urinary protein-creatinine ratio was found in 3% of S. mansoni-infected children and in 5% of Sudanese controls but in none of the European children. Characterization of pathological proteinuria using albumin nephelometry, alpha-1 microglobulin immunodiffusion and SDS-polyacrylamide gel electrophoresis in these children showed glomerular, tubular or mixed glomerulotubular patterns. One, 4 and 6 months following treatment of schistosomiasis with praziquantel, stools were re-examined; 57% of patients were cured, 16% were found to be reinfected and 27% had persistent egg excretion. Six months after therapy, pathological urinary protein-creatinine ratios were encountered in 3% of S. mansoni patients and in none of the 34 reinvestigated controls. Proteinuria was similar in patients with persistent S. mansoni egg excretion and in children cured of schistosomiasis infection. It is concluded that there was no evidence for S. mansoni associated glomerulonephritis in this group of Sudanese children. The high rate of pathological proteinuria in S. mansoni-infected and non-infected Sudanese children may be due to other causes.
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Affiliation(s)
- M Elsheikh
- Department of Medicine, University of Gezira, Sudan
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38
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Abstract
Schistosomiasis mansoni is a chronic helminthic disease that affects about 100 million people in the tropics. The worms have a life span of 5 to 10 years, and they live in the mesenteric veins of the host. Lightly infected individuals are asymptomatic or manifest mild intestinal symptoms. Heavily infected individuals often develop severe morbidity with hepatosplenomegaly, sometimes with a fatal outcome. Morbidity is attributed to the strong humoral and T-cell-mediated host immune responses developed to a variety of parasite antigens and expressed as tissue inflammations. The immunopathology includes dermatitis, immune complex-mediated kidney disease, and, chiefly, T-cell-mediated granuloma formation and fibrosis around disseminated parasite eggs. This review describes the mechanisms of induction and expression of immunopathology in infected persons and experimental animals. Immunoregulatory mechanisms that modulate the enhanced immune responses and may ameliorate excessive morbidity are discussed.
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Affiliation(s)
- D L Boros
- Department of Immunology and Microbiology, School of Medicine, Wayne State University, Detroit, Michigan 48201
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39
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Martinelli R, Noblat AC, Brito E, Rocha H. Schistosoma mansoni-induced mesangiocapillary glomerulonephritis: influence of therapy. Kidney Int 1989; 35:1227-33. [PMID: 2504987 DOI: 10.1038/ki.1989.114] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Schistosomiasis mansoni has been well documented as one of the causes of infectious glomerulopathy, with mesangiocapillary glomerulonephritis being the most frequent lesion observed in this condition. Twenty-one patients with hepatosplenic schistosomiasis mansoni and biopsy-documented mesangiocapillary glomerulonephritis (MCGN) were studied and compared with 19 patients with the idiopathic form of MCGN. Nephrotic syndrome was the most frequent clinical presentation in both groups. At the time of diagnosis nine patients with hepatosplenomegaly (4 with associated arterial hypertension) and 12 (8 with arterial hypertension) among the patients with idiopathic MCGN had renal insufficiency. At the end of the follow-up period 16 patients with hepatosplenic schistosomiasis and MCGN (75.2 months) and 15 with the idiopathic form (52.1 months) had renal failure. Also, when compared at 48 months of follow-up, no difference in renal function could be detected in both groups. No benefits related to anti-parasitic treatment in the schistosomiasis group and immunosuppression therapy in either group could be documented. The progression of the renal disease, as assessed by the reciprocal of serum creatinine versus time, and the survival curve, were not different between the two groups. It is concluded that MCGN in patients with the hepatosplenic form of schistosomiasis mansoni is a progressive disease not influenced by anti-parasitic or immunosuppressive therapy, and presents a clinical course similar to that of the idiopathic form.
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Affiliation(s)
- R Martinelli
- Department of Medicine and Pathology, Federal University of Bahia, Salvador, Brazil
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40
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Abu-Romeh SH, van der Meulen J, Cozma MC, al-Tamimi N, Ali JH, Cozma G, Adnani MS, Johny KV. Renal diseases in Kuwait. Experience with 244 renal biopsies. Int Urol Nephrol 1989; 21:25-9. [PMID: 2497078 DOI: 10.1007/bf02549898] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The biopsy slides and clinical data on 244 patients who underwent percutaneous renal biopsies in the last 4 years in Kuwait were retrospectively reviewed. The data were analysed to show a correlation between clinical presentation and histological findings. We noted a high incidence of membranoproliferative glomerulonephritis (MPGN) presenting as nephrotic syndrome in association with schistosomal infection, an endemic disease in many of the neighbouring countries. Lupus nephritis was also observed at a relatively increased incidence compared with the West. On the other hand, amyloidosis and IgA nephropathy were less common, 5% for each.
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Affiliation(s)
- S H Abu-Romeh
- Department of Medicine, Faculty of Medicine, Kuwait University
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41
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Santos WL, Ramos EA, Pereira LJ, Martinelli R, Brito E, Andrade ZA, Rocha H. Schistosomal glomerulonephritis: is it more prevalent in hepatosplenic patients when cor pulmonale is present? Rev Soc Bras Med Trop 1989; 22:51-2. [PMID: 2517804 DOI: 10.1590/s0037-86821989000100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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42
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Ali-Khan Z, Sipe JD, Du T, Riml H. Echinococcus multilocularis: relationship between persistent inflammation, serum amyloid A protein response and amyloidosis in four mouse strains. Exp Parasitol 1988; 67:334-45. [PMID: 3191961 DOI: 10.1016/0014-4894(88)90080-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
LPS-hyporesponsive (C3H/HeJ) and LPS-sensitive (C57BL/6, CBA/J, C3H/HeSn) strains of mice were infected intraperitoneally with 50 alveolar hydatid cysts (AHC) to assess the effect of protracted severe inflammation on serum amyloid A protein (SAA) concentrations, splenic amyloid deposition, and pre- and postamyloidotic alterations in the splenic architecture. In general, the SAA concentrations in all the four mouse strains showed a moderate but steady increase throughout the course of infection. Splenic amyloid deposition commenced between 6 to 8 weeks postinfection (p.i.) when the SAA concentrations were relatively low and increased progressively until 12 weeks p.i. when 52 to 78% of the splenic parenchyma was obliterated. CBA mice which harbored the largest AHC throughout the 12-week course of infection showed the poorest SAA and amyloid responses; the situation was reversed in the C3H/HeSn strain. Histologically, most of the splenic follicles, during the stage of maximum amyloid deposition, appeared hypocellular. Their T-cell-dependent periarterial sinuses were either totally depleted of cells or contained plasma cells or myeloid cells. These results show that (a) there is no direct correlation between the intensity of inflammation, SAA concentrations, or amounts of amyloid deposition in either of the four mouse strains and (b) amyloidosis secondary to AHC infection differs from other experimental mouse models of amyloidosis in the magnitude of SAA elevation during the preamyloid phase.
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Affiliation(s)
- Z Ali-Khan
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
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43
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Abstract
Brazil is a large country with different population densities in its five geographical regions, each of which has severe but unevenly distributed socioeconomic problems which affect the health care system. This makes the accurate assessment of renal disease in the large paediatric population which comprises 40% of the total population especially difficult. This paper analyses the experience of one paediatric nephrology unit. Urinary tract infection affecting 44% of the patients was the most common disease. There was a high incidence of vesicoureteric reflux and renal scarring. The proportion of poststreptococcal glomerulonephritis did not exceed 11%, whilst nephrotic syndrome in its various forms represented 20% of the patients. End-stage renal failure was common and difficult to manage. Renal transplantation could not meet the demand for a variety of reasons, thus there has been an alarming annual increase in the number of patients on dialysis. Other diseases encountered in smaller numbers included acute renal failure, other glomerulopathies (mainly IgA), tubulopathies and renal lithiasis.
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Affiliation(s)
- J S Diniz
- Department of Pediatrics, School of Medicine, Clinical Hospital, UFMG Belo Horizonte, Brazil
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44
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Manca F, Cauda R, Laghi V, Trovatello G, Cantarella S, Tresalti E, Ortona L, Celada F. Detection of parasite related antigens associated with conglutinin binding immune complexes in patients with Schistosoma haematobium. Trans R Soc Trop Med Hyg 1988; 82:254-7. [PMID: 3142115 DOI: 10.1016/0035-9203(88)90437-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
An ELISA assay was designed to detect the presence of parasite related antigens associated with circulating immune complexes in patients affected by urinary schistosomiasis. The assay makes use of bovine conglutinin as the immune complex recognition unit and of human anti-Schistosoma antibody as the antigen recognition unit. Using this method we showed that 10 of 15 (67%) patients with a positive polyethylene glycol assay had circulating immune complexes in which parasite antigens could be detected.
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Affiliation(s)
- F Manca
- Department of Immunology, XIII USL - University of Genoa, Italy
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45
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Turner I, Ibels LS, Alexander JH, Harrison A, Moir D. Minimal change glomerulonephritis associated with Schistosoma hematobium infection--resolution with praziquantel treatment. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1987; 17:596-8. [PMID: 3128971 DOI: 10.1111/j.1445-5994.1987.tb01267.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In a patient presenting with hematuria and proteinuria (albuminuria), bladder biopsy demonstrated Schistosoma hematobium infection and renal biopsy showed a minimal change glomerulonephritis. The hematuria and proteinuria resolved following praziquantel therapy. The pathogenesis of glomerulonephritis in association with Schistosoma infection is discussed.
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Affiliation(s)
- I Turner
- Department of Renal Medicine, Royal North Shore Hospital, St. Leonards, NSW
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46
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Ali-Khan Z, Rausch RL. Demonstration of amyloid and immune complex deposits in renal and hepatic parenchyma of Alaskan alveolar hydatid disease patients. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1987; 81:381-92. [PMID: 3446028 DOI: 10.1080/00034983.1987.11812136] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Histopathological changes and the incidence of amyloid and immune complex (IC) deposits were examined in six liver (autopsy or biopsy) and two kidney (autopsy) samples from seven Alaskan alveolar hydatid disease (AHD) patients. Both the kidney samples showed evidence of severe nephropathy and glomerular IC deposits. Two of the six liver samples had typical amyloid deposits. All the liver samples examined showed variable amounts of parenchymal atrophy adjacent to the locus of larval Echinococcus multilocularis, periportal and portal fibrosis. Thus secondary amyloidosis and IC-mediated pathological changes should be included as possible complications of AHD.
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Affiliation(s)
- Z Ali-Khan
- Department of Microbiology and Immunology, School of Medicine, McGill University, Montreal, Quebec, Canada
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47
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Korzets Z, Bernheim J, Bernheim J. Rapidly progressive glomerulonephritis (crescentic glomerulonephritis) in the course of type I idiopathic membranoproliferative glomerulonephritis. Am J Kidney Dis 1987; 10:56-61. [PMID: 3605084 DOI: 10.1016/s0272-6386(87)80012-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Membranoproliferative glomerulonephritis is a chronic glomerulopathy with a generally progressive course toward end-stage renal disease and a high recurrence rate in renal allografts. Described herein is the appearance of rapidly progressive glomerulonephritis (crescentic glomerulonephritis) in the course of type I membranoproliferative glomerulonephritis. This transition occurred within 6 weeks, documented histologically by an initial and subsequent renal biopsy. No recurrence of the disease was noted in a living donor graft 18 months posttransplantation.
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48
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Ramos EA, Andrade ZA. Chronic glomerulonephritis associated with hepatosplenic Schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 1987; 29:162-7. [PMID: 3124247 DOI: 10.1590/s0036-46651987000300008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In a series of 36 cases of renal disease associated with hepatosplenic schistosomiasis the following morphologic types of glomerulonephritis were found: mesangio-capillary (33.2%), mesangial proliferative (25.0%), focal glomerular sclerosis (16.7%) and sclerosing glomerulonephritis (8.3%). No significant statistical differences were found when these results were compared with those from 36 cases of glomerulonephritis not associated with hepatosplenic disease. On the other hand, endocapillary glomerulonephritis was found to be predominant in the latter group of cases. These results did not substantiate the assumption that mesangio-capillary glomerulonephritis is specifically related to hepatosplenic schistosomiais. However, if the types of glomerulonephritis that predominantly involve the me-sangium are considered together, they are significantly associated with hepatosplenic schistosomiasis. Mesangial involvement is known to occur in other parasitic diseases and that may be related to a common immunopathogenesis.
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49
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Sobh MA, Moustafa FE, el-Housseini F, Basta MT, Deelder AM, Ghoniem MA. Schistosomal specific nephropathy leading to end-stage renal failure. Kidney Int 1987; 31:1006-11. [PMID: 3108566 DOI: 10.1038/ki.1987.99] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In this study 17 patients, 11 with end-stage renal failure and six with nephrotic syndrome were selected. The selection criteria were presence of active intestinal schistosomiasis and absence of any surgical or other medical disease which could explain the renal disease. When examined by light microscopy, kidney biopsies showed membranoproliferative glomerulonephritis in nine, membranous in four, focal segmental glomerulosclerosis in two, sclerosing glomerulonephritis in one case, and no changes in another case. Direct immunofluorescence showed IgG deposits in 13 cases, IgM in 10 and different complement components (C3, C1q) in eight cases. Eluates from the kidney biopsies of the 17 schistosomal as well as six control cases were examined by ELISA against schistosoma mansoni adult worm antigen (AWA). This test showed the presence of antibodies against the AWA in 12 out of 17 of the schistosomal cases, and zero out of six of the controls. When examined by direct IFA using sheep anti-circulating anodic antigen/FITC and by indirect IFA using monoclonal antischistosomal CAA IgG3, kidney biopsies of the ELISA positive cases showed granular deposits of circulating anodic antigen (CAA). We conclude that schistosomal specific nephropathy does exist in the clinical settings and can lead to end-stage renal disease, with CAA probably being a major responsible antigen.
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50
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Watt G, Long GW, Calubaquib C, Ranoa CP. Prevalence of renal involvement in Schistosoma japonicum infection. Trans R Soc Trop Med Hyg 1987; 81:339-42. [PMID: 3113006 DOI: 10.1016/0035-9203(87)90257-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
244 outpatients and 100 hospitalized patients with confirmed Schistosoma japonicum infection were prospectively surveyed for the presence of nephropathy. There was no association between schistosomiasis and renal disease in the outpatient group. Three hospitalized patients had evidence of significant nephropathy, but this number was not significantly higher than in a control group of 100 hospitalized age and sex-matched control patients without schistosomiasis. One schistosomiasis patient with severe nephrotic syndrome underwent percutaneous renal biopsy. Neither S. japonicum antigen nor antibody was found in the biopsy specimen. 64 of the 100 hospitalized patients had portal hypertension; in 28 patients there was hepatic decompensation. Only one of these hepatosplenic patients had evidence of renal disease. Thus renal involvement was uncommon in patients presenting various manifestations of chronic S. japonicum infection, including those with severe hepatosplenic disease. These results contrast markedly with S. mansoni infection, in which nephropathy associated with advanced liver disease is a distinct, well-recognized clinical entity.
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