Renal leishmaniasis as unusual cause of nephrotic syndrome in an HIV patient.

Renal involvement is a rare complication in HIV-1-infected patients leading to various pathologies and clinical symptoms. In addition to the classic HIV-1-associated nephropathy with collapsing-type focal segmental glomerulosclerosis and characteristic tubulocystic changes, which is more common in Afro-American than in Caucasian HIV-1 patients, immune complex GNs such as membranous GN and membranoproliferative GN are particularly common renal manifestations. Besides HIV-1 itself, a number of opportunistic infections may cause renal disease in HIV-1-infected patients. In this study, we report an unusual case of HIV-1 infection with a severe renal manifestation of systemic leishmaniasis that developed years after repeated visits to Mediterranean countries. The case presents several remarkable clinical, pathologic, and therapeutic aspects that may be important for daily clinical practice.

Childhood nephrotic syndrome in Cambodia: an association with gastrointestinal parasites.

OBJECTIVES: To describe childhood nephrotic syndrome (NS) in Cambodia and to evaluate whether initial presentation or relapse is associated with gastrointestinal parasitic infection. STUDY DESIGN: We reviewed the records of 112 children with NS. A retrospective cross-sectional study compared 99 stool exams from 63 children with NS with 12 365 stool exams from 9495 controls. RESULTS: The male-to-female ratio was 1.7; the mean age of presentation was 8.95 years--44% were hypertensive, 44% had microscopic hematuria, 40% had eosinophilia, and 41% had acute renal failure; 92.7% were steroid sensitive, 12.7% were steroid dependent, and 8.9% were frequent relapsers. Peritonitis and death were rare outcomes. Giardia lamblia (OR, 3.62; 95% CI, 2.0 to 6.1), Strongyloides stercoralis (OR, 3.59; 95% CI, 1.3 to 8.2), and Hookworm species (OR, 2.57; 95% CI, 1.0 to 5.5) were more likely to be isolated from the children with NS than the controls. CONCLUSIONS: The clinical course of childhood NS in Cambodia is similar to the developed world. Differences at presentation included older age and increased prevalence of microscopic hematuria, hypertension, eosinophilia, and acute renal failure. This study demonstrates an association between G lamblia, S stercoralis, and possibly Hookworm species and the onset of NS.

Toxocariasis and nephrotic syndrome.

We describe a case of toxocariasis as a rare cause of nephrotic syndrome in an adult woman. This rare association was confirmed by elevated Toxocara-specific immunoglobulin M titers. Renal biopsy was not done because of prolonged activated partial thromboplastin time. Our patient was treated with prednisone and albendazole. These treatments resulted in partial remission of renal symptoms as well as the abatement of the Toxocariasis infection. The relationship between toxocariasis infection and glomerular disease is still unclear. In the literature, exceptional renal impairment secondary to toxocariasis have been described, especially in children. To the best of our knowledge, this is the second case of nephrotic syndrome associated with toxocariasis in adults.

Pathophysiology of malaria.

The pathophysiology of malaria infection is presented from animal studies and the various manifestations occurring in human cases. Maegraith (1974) proposed the concept of a chain reaction of physiological processes that leads to the disease following malarial infection. It may be seen that the malaria parasites first damage the infected red blood cells directly and then initiate a chain reaction of nonspecific inflammatory processes and later on immunological responses aggravating further the inflammatory reactions. Because of ther interdependence in nature of these changes as suggested by Maegraith in 1977 it is usually difficult to clearly identify these three mechanisms.

[Glomerular nephropathy and schistosomiasis (author's transl)]. / Néphropathie glomérulaire et schistosomiase.

Glomerular lesion appears frequently in patients with S. mansoni or S. japonicum infection. This nephropathy may bring clinical changes and leads to severe evolution with letal risk. It may be induced or aggravated by the specific treatment but it has then, in most cases, a short duration and a good prognosis. Specific treatment fixed in order to reduce the amount of circulating antigens may be benefic. In some cases, on the contrary, the nephropathy is not reactive to any specific or symptomatic treatment and has an evolution of its own under the action of various factors; the most important is the hepatosplenic damage. Consequently glomerular function must be controlled in patients with schistosomiasis in order to fix the prognosis and the treatment.

A nephrotic syndrome of tropical origin: case report and short review of the aetiology.

We present a case of nephrotic syndrome in a 38-year-old man of Ivorian origin. In the search of the cause of his illness an infection with Plasmodium malariae (P. malariae) was diagnosed by serology and by microscopy of a Giemsa thin blood smear which revealed rare gametocytes of P. malariae. Proteinuria significantly diminished within three months after antimalarial treatment. Antibodies against Schistosoma were detected as well. Examination of kidney biopsy revealed a discrete mesangioproliferative glomerulonephritis. This case highlights that a thorough history-taking may be essential and that infectious diseases should be included in the differential diagnostic thinking process when a nephrotic syndrome is diagnosed.

Serological markers of viral, syphilitic and toxoplasmic infection in children and teenagers with nephrotic syndrome: case series from Mato Grosso State, Brazil.

Some infections can be the cause of secondary nephrotic syndrome. The aim of this study was to describe the experience of a Renal Disease Reference Clinic from Central Brazil, in which serological markers of some infectious agents are systematically screened in children with nephrotic syndrome. Data were obtained from the assessment of medical files of all children under fifteen years of age, who matched nephrotic syndrome criteria. Subjects were tested for IgG and IgM antibodies against T. gondii and cytomegalovirus; antibodies against Herpes simplex, hepatitis C virus and HIV; and surface antigen (HBsAg) of hepatitis B virus. The VDRL test was also performed. 169 cases were studied. The median age on the first visit was 44 months and 103 (60.9%) patients were male. Anti-CMV IgG and IgM were found in 70.4% and 4.1%, respectively. IgG and IgM against Toxoplasma gondii were present in 32.5% and 5.3%, respectively. Two patients were positive for HBsAg, but none showed markers for HIV, hepatitis C, or Treponema pallidum. IgG and IgM against herpes simplex virus were performed on 54 patients, of which 48.1% and 22.2% were positive. IgM antibodies in some children with clinical signs of recent infection suggest that these diseases may play a role in the genesis of nephrotic syndrome.

Nephrotic syndrome associated with toxoplasmosis: report of seven cases.

The concomitance of nephrotic syndrome and acute infection by Toxoplasma gondii is a rare occurrence in humans. In this paper seven cases of children, ranging from 11 months to 7 year-old, with concomitant nephrotic syndrome and asymptomatic acute T. gondii infection are reported. In one of those patients only the administration of anti-Toxoplasma therapy was enough to control the clinical and laboratory manifestations of the disease. In the other patients it was necessary to introduce corticosteroids or other immunosuppressant drugs. Three patients had complete clinical and laboratory improvement and the remaining showed only a partial response.

Nephrotic syndrome and unrecognized Plasmodium malariae infection in a US Navy sailor 14 years after departing Nigeria.

A 34-year-old Nigerian man presented with nephrotic syndrome. Renal biopsy revealed chronic membranous glomerulopathy with focal segmental sclerosis. Blood Giemsa smear contained rare Plasmodium sp. trophozoites and small subunit ribosomal RNA polymerase chain reaction amplification confirmed the presence of Plasmodium malariae. This case highlights the importance of obtaining even remote travel histories from ill immigrants and considering occult quartan malaria in patients from endemic locations with nephrotic syndrome.

Serological mareers of viral, syphilitic and tooplasmic infection in children and teenagers with nephrotic syndrome: case series from mato grosso state, Brazil / Marcadores sorológicos de infecções virais, sífilis e toxoplasmose em crianças e adolescentes com síndrome nefrótica: série de casos de Mato Grosso, Brasil

Some infections can be the cause of secondary nephrotic syndrome. The aim of this study was to describe the experience of a Renal Disease Reference Clinic from Central Brazil, in which serological markers of some infectious agents are systematically screened in children with nephrotic syndrome. Data were obtained from the assessment of medical files of all children under fifteen years of age, who matched nephrotic syndrome criteria. Subjects were tested for IgG and IgM antibodies against T. gondii and cytomegalovirus; antibodies against Herpes simplex, hepatitis C virus and HIV; and surface antigen (HBsAg) of hepatitis B virus. The VDRL test was also performed. 169 cases were studied. The median age on the first visit was 44 months and 103 (60.9%) patients were male. Anti-CMV IgG and IgM were found in 70.4% and 4.1%, respectively. IgG and IgM against Toxoplasma gondii were present in 32.5% and 5.3%, respectively. Two patients were positive for HBsAg, but none showed markers for HIV, hepatitis C, or Treponema pallidum. IgG and IgM against herpes simplex virus were performed on 54 patients, of which 48.1% and 22.2% were positive. IgM antibodies in some children with clinical signs of recent infection suggest that these diseases may play a role in the genesis of nephrotic syndrome.

Algumas infecções podem ser causa de síndrome nefrótica. O objetivo desse estudo foi descrever a experiência de clínica pediátrica de doenças renais do Brasil Central, onde marcadores sorológicos de algumas doenças infecciosas são sistematicamente avaliados em crianças com síndrome nefrótica. Dados foram obtidos de registros médicos de todas as crianças com menos de 15 anos que preenchiam critérios de síndrome nefrótica. Os participantes foram testados para presença de IgG e IgM contra Toxoplasma gondii e citomegalovirus; anticorpos contra herpes simples, vírus da hepatite C e HIV, além do antígeno de superfície da hepatite B (HBsAg). VDRL também foi testado. 169 casos foram estudados. A idade média na primeira visita foi 44 meses e 103 eram do sexo masculino (60.9%). Anti-CMV IgG e IgM foram identificados em 70,4% e 4,1%, respectivamente. IgG e IgM contra T. gondii eram positivos em 32,5% e 5,3%. Dois pacientes eram HBsAg positivos, mas nenhum mostrou positividade para HIV, hepatite C ou sífilis. IgG e IgM contra herpes simples foram realizados em 54 pacientes, dos quais 48,1% e 22,2% eram positivos. Anticorpos IgM positivos em algumas crianças com sinais clínicos de infecção recente sugerem que essas doenças podem exercer um papel na gênese da síndrome nefrótica.

Nephrotic syndrome associated with toxoplasmosis: report of seven cases / Síndrome nefrótica associada à toxoplasmose: relato de sete casos

The concomitance of nephrotic syndrome and acute infection by Toxoplasma gondii is a rare occurrence in humans. In this paper seven cases of children, ranging from 11 months to 7 year-old, with concomitant nephrotic syndrome and asymptomatic acute T. gondii infection are reported. In one of those patients only the administration of anti-Toxoplasma therapy was enough to control the clinical and laboratory manifestations of the disease. In the other patients it was necessary to introduce corticosteroids or other immunosuppressant drugs. Three patients had complete clinical and laboratory improvement and the remaining showed only a partial response.

Ocorrência concomitante de síndrome nefrótica e infecção aguda por Toxoplasma gondii em seres humanos é situação pouco frequente. No presente trabalho são relatados sete casos de crianças, com idade variável entre 11 meses e sete anos, que apresentavam síndrome nefrótica e infecção aguda por T. gondii assintomática. Em um dos pacientes o tratamento específico anti-Toxoplasma foi suficiente para controlar clínica e laboratorialmente as manifestações da doença. Nos demais foi preciso administrar corticosteróides ou outras drogas imunossupressoras. Após introdução desse esquema três pacientes apresentaram remissão completa dos sintomas; os demais apenas remissão parcial.

Quartan malarial nephrotic syndrome in children.

Quartan malarial infection causes an immune complex nephritis in some individuals, which, once established, is sustained by mechanisms not yet fully explained, but which probably involve autoimmune processes. The presenting clinical and biochemical findings of the quartan malarial nephrotic syndrome are similar to those classically described for the nephrotic syndrome in childhood, but the renal pathology seen on light, electron, and immunofluorescent microscopy show striking differences and distinctive features. The disease tends to pursue a chronic course and in most patients is nonresponsive to treatment with antimalarial drugs, prednisolone, and immunosuppresive drugs. The overall prognosis is poor, with most patients developing hypertension and evidence of renal failure within 3 to 5 years of onset.

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.