Granulomatous nephritis and meningoencephalomyelitis caused by Halicephalobus gingivalis in a pony gelding.

A ten-year-old Shetland pony gelding showed low appetite, ataxia, peculiar swaying, clouding of consciousness, and ultimately died. At necropsy, multiple coalescing granulomatous foci were detected in the kidneys, and small necrotic lesions were found in the cerebellum. Histologic examination of the renal tissue sections revealed extensive granuloma, and Halicephalobus gingivalis-like nematodes were seen. Similar nematodes were found in the granulomatous or necrotic lesions of the renal lymph nodes and cerebellum, and were also frequently detected in cerebrospinal meningovascular lesions. Morphologic features together with partial ribosomal RNA gene sequences of the nematodes in the lesions revealed that they were H. gingivalis. The present results indicated that H. gingivalis caused granulomatous nephritis and meningoencephalomyelitis in this pony gelding.

Granulomatous nephritis in psittacines associated with parasitism by the trematode Paratanaisia spp.

Trematodes belonging to the family Eucotylidae are parasites of the kidney and ureter, and affect several bird species. However, psittacines have not been identified as hosts of these parasites. Three birds, an adult female blue and gold macaw (Ara ararauna), an adult female blue-winged macaw (Propyrrhura maracana) and an adult male white-eared parakeet (Pyrrhura leucotis) were admitted at the Veterinary Hospital of the Fundação Zoo-Botânica de Belo Horizonte, Brazil (FZB/BH). All three birds had severe dehydration and cachexia. The blue and gold macaw presented with dyspnea, apathy, and incoordination. Blood cell counts indicated discrete anemia and leucopenia. Blood biochemistry revealed significant increase in levels of uric acid (61 mg/dl) and blood urea nitrogen (22 mg/dl). The bird died within 24 h after admission. The other two birds were admitted with similar clinical signs, but died prior to a complete clinical examination. At the necropsy, in all the three birds, the kidneys were enlarged with brown-yellowish discoloration and irregular cortical surface. On the cut surface, there was a brown-yellowish material with few visible parasites flowing out of the parenchyma. When fragments of the kidneys were placed in 10% formalin, a large number of trematodes came out of the renal parenchyma. The parasites were identified as Paratanaisia robusta infecting all three birds, and P. bragai infecting the blue-winged macaw and the white-eared parakeet. Histologically, there was an interstitial, multifocal to coalescent, lymphoplasmacytic infiltrate with some epithelioid macrophages, and a few heterophils, characterizing a granulomatous nephritis. Adult worms and eggs were observed within dilated tubules and in the renal pelvis. In the blue and gold macaw, some parasite eggs were located interstitially associated with an intense adjacent granulomatous reaction.

A female patient with malarial nephropathy.

Malaria remains one of the world's major health problems, particularly in developing tropical countries. Imported malaria is reportedly increasing in Western countries. Acute renal failure (ARF) is the most common cause of death in severe malaria. We report the case of a 63-year-old female patient with a history of travel to a rural area in South Africa who was in coma and had a high fever on admission. Thirty percent of her erythrocytes were infected with Plasmodium falciparum. She had cerebral malaria, malarial nephropathy, anemia, hepatic dysfunction, and disseminated intravenous coagulation (DIC). Quinine and artesunate treatment decreased the number of parasites in the blood. To manage renal failure, hemodialysis was performed for 11 days. A relationship between ARF and hepatic dysfunction was suggested. This relationship is an indication of the clinical course of the disease. In this article, we discuss the mechanism underlying the development of malarial nephropathy and its management, particularly the usefulness of hemodialysis.

[Case report: tenesmus in a cow with a liver abscess and nephritis]. / Fallbericht. Tenesmus bei einer Kuh mit Leberabszess und Nephritis.

A two-year-old Swiss Braunvieh cow was referred to our clinic because of tenesmus and weight loss. Clinical examination revealed a moderately abnormal general behaviour and condition, thin body condition and a rectal temperature of 40.1 degrees C. Tenesmus was evident, and rumen and intestinal motility were markedly reduced. All tests for a reticular foreign body were positive. On rectal examination, a round, smooth, firm, non-painful mass with a diameter of approximately 15 cm was palpated far cranially on the right side. Abnormal haematological and biochemical findings included marked anaemia, neutrophilic leucocytosis, markedly elevated concentration of fibrinogen and mildly elevated gamma-glutamyl-transferase activity. The clotting time of the glutaraldehyde test was one minute. Ultrasonographic examination revealed abscesses involving the liver and extending caudally into the right flank region. The liver parenchyma had diffuse changes. Because of a grave prognosis, the cow was euthanized. Postmortem findings substantiated ultrasonographic results; there were abscesses, caused by Fasciola hepatica infestation, originating in the liver and extending into the right flank. As well, there was severe, bilateral, multifocal, suppurative nephritis due to thromboembolism. Based on all the findings, a diagnosis of liver abscess caused by fascioliasis and bilateral suppurative nephritis was made.

Effects of a parasite-induced nephritis on osmoregulation in the common carp Cyprinus carpio.

Carp Cyprinus carpio infected with the haemoflagellate Trypanoplasma borreli undergo progressive nephritis associated with a destruction of approx. 40% of the nephric tubules. In an attempt to analyse the effect of the nephritis on the osmoregulation of affected carp, the clinical chemical properties of plasma and urine samples were analysed. Parasitised carp excreted greater amounts of electrolytes in their urine than uninfected carp which excreted highly diluted urine with an osmolality of about 10% of plasma osmolality. During the course of the infection, urine osmolality increased up to 26% of plasma osmolality by Day 21 post-infection (p.i.). The plasma:urine ratio of Na+ also increased, while concomitant losses of Mg2+, Ca2+, K+ and inorganic phosphate were less pronounced. Infected carp were able to maintain a normal solute balance in their plasma. Plasma hydration (indicated by decreased protein contents) occurred on Day 21 p.i. Our data indicate that in T. borreli-infected carp, reabsorption processes of the distal renal tubule were disturbed, while secretory and absorption processes in the proximal tubule appeared to be less affected. In addition, infected carp were able to compensate their increased ion losses, probably by (energy-consuming) active absorption processes. The energy budget of infected carp was additionally affected by a substantial direct consumption of plasma glucose by the parasite.

Use of urine samples from healthy humans, nephritis patients or other animals as an alternative to foetal calf serum in the culture of Leishmania (L.) donovani in vitro.

The effect of supplementing in-vitro cultures of Leishmania donovani with urine was investigated. The parasites were isolated from Bangladeshi patients with visceral leishmaniasis. The urine samples used were collected from healthy human donors, patients with nephrotic syndrome, diabetic nephritis (DN) or diabetes mellitus, a dog and a cow. Promastigotes from blood-agar cultures were inoculated into RPMI-1640 basal medium with 10% heat-inactivated foetal calf serum (FCS) and/or 1%-20% urine. The parasites were then counted in a haemocytometer, on days 2, 4, 5, 6, 7, 8, 10, 12 and 14 post-inoculation. From day 4, the numbers of parasites/ml in cultures containing 5% healthy-human urine but no FCS were at least as high as those in cultures containing 10% FCS but no urine (P = 0.191). The wet weights of parasites harvested from mass cultures of the parasites in RPMI-1640 plus 5% healthy-human urine and in RPMI-1640 plus 10% FCS were practically the same. Multiplication of the parasites in the presence of 5% urine from a DN patient was significantly greater (P < 0.01) than that seen with other urine samples at the same concentration or with 10% FCS. The multiplication seen with 8% canine urine was almost the same as with 5% healthy-human urine. Parasites could be maintained in RPMI-1640 plus 5% healthy-human urine for at least 40 days, sub-culturing every 4 days. Urine may be a better and much cheaper stimulant of Leishmania multiplication in vitro than FCS.

Upregulation of major histocompatibility complex (MHC) antigen in nephritis associated with murine malaria infection.

The importance of immune complexes in the pathogenesis of malarial nephritis is well established. The expression was studied of major histocompatibility complex (MHC) class I and class II antigens and the infiltration of inflammatory cells, with their possible roles in cellular immune reactions in the pathogenesis of nephritis in a murine malaria model. Thirty-six kidney sections obtained on days 5, 8-10, 15, and 20 from C57BL/6J mice acutely infected with Plasmodium berghei and uninfected control mice were stained with specific antibodies for cellular immune markers by immunohistochemistry. From day 10 post-infection, markedly enhanced expression of both MHC class I and class II (Ia) antigens was observed in the kidneys. In the glomeruli, the expression was in the mesangium and along the capillaries. MHC class II was strongly expressed in the proximal tubules. Enhanced expression of MHC class I and class II was found in the endothelium of blood vessels, especially the peritubular capillaries. In addition, immune cells positive for CD4+ and CD8a+ markers, and class I and class II antigens were present around small arteries, or in focal areas of the interstitium. There were strong correlations between MHC class I expression in the glomeruli; MHC class II expression in the glomeruli/proximal tubules; and CD4+, CD8a+ infiltrates in the tubulointerstitium; with the severity of renal dysfunction (proteinuria). These findings indicate the importance of cellular immune reactions in the pathogenesis of acute murine malarial nephritis.

In situ analysis of adhesion molecule expression in kidneys infected with murine malaria.

The expression of intercellular adhesion molecule-1 (ICAM-1), the ligand leucocyte function antigen-1 (LFA-1, CD11a), and complement receptor type 3 (CR3, or Mac-1, CD11b) has been studied in murine kidneys acutely infected with the fatal malaria parasite Plasmodium berghei ANKA. Thirty-six kidney sections from five groups of C57BL/6J mice on day 5, 10, 15, and 20 post-infection, and normal controls, were stained with monoclonal antibodies against ICAM-1, LFA-1, and Mac-1. There was markedly enhanced expression of ICAM-1 in the glomerular mesangium and the endothelium of blood vessels from day 10 post-infection. ICAM-1 was also found in the proximal tubular epithelial cells in an apical location, with a linear pattern. In addition, the glomeruli showed positive staining for LFA-1 and Mac-1 on day 10 post-infection, mainly in the infiltrating inflammatory cells. Mesangial cells and inflammatory cells in the cortical tubulointerstitium showed positive staining for ICAM-1, LFA-1, and Mac-1 at the later stages of infection. There were strong correlations between ICAM-1 expression on endothelial cells of glomerular/peritubular capillaries with inflammatory cells positive for LFA-1 and Mac-1, which correlated with proteinuria. These findings show that several adhesion molecules are up-regulated in murine malaria-associated nephritis. The expression of ICAM-1 on endothelial cells correlated with the severity of inflammatory responses, indicating the relationship between the expression of adhesion molecules and cell-mediated immune renal injury. It is suggested that adhesion molecules play an important role in the pathogenesis of murine nephritis. Better knowledge of the function of these molecules in malaria infection may open new approaches to antimalarial therapy.

Cell-mediated pathology during murine malaria-associated nephritis.

We have studied the cellular mechanisms involved in the development of nephritis during acute and chronic murine malaria infections induced by Plasmodium vinckei petteri and P. berghei respectively. Albuminuria and uraemia were observed during the early stages of both types of infection, and were associated with glomerular and interstitial hypercellularity. There was a gradual increase in numbers of CD45+ cells from the early stages of both infections onwards. These infiltrates contained CD4+ and CD8+ cells and mononuclear phagocytes. The interstitial and glomerular hypercellularity was due to an influx of inflammatory cells rather than an increase in renal cell division. These findings indicate the importance of cell-mediated immune mechanisms in the development of nephritis during murine malaria and illustrate an example of naturally occurring infection-induced nephritis.

Filarial nephritis: a cause of nephrotic syndrome.

A 26-year-old male presented with oedema, massive albuminuria and microscopic haematuria. Kidney biopsy revealed enlarged cellular glomeruli infiltrated by polymorphs and eosinophils with focal fibrin deposits along the basement membrane. Microfilariae were seen in the lumen of few glomerular capillaries. Antistreptolysin titre was negative. The absence of other aetiological factors and presence of microfilariae within glomeruli suggests that nephrotic syndrome may be due to a filarial nephritis.