Novel kidney injury biomarkers in tropical infections: a review of the literature.

Tropical diseases are mainly found in the tropical regions of Asia, Africa and Latin America. They are a major Public Health problem in these regions, most of them are considered neglected diseases and remain as important contributors to the development of AKI (Acute Kidney Injury), which is associated with increased patients' morbidity and mortality. In most countries, kidney disease associated to tropical diseases is attended at health services with poor infrastructure and inadequate preventive measures. The long-term impacts of these infections on kidney tissue may be a main cause of future kidney disease in these patients. Therefore, the investigation of novel kidney injury biomarkers in these tropical diseases is of utmost importance to explain the mechanisms of kidney injury, to improve their diagnosis and prognosis, as well as the assessment to health systems by these patients. Since 2011, our group has been studying renal biomarkers in visceral and cutaneous leishmaniasis, schistosomiasis, leptospirosis and leprosy. This study has increased the knowledge on the pathophysiology of kidney disease in the presence of these infections and has contributed to the early diagnosis of kidney injury, pointing to glomerular, endothelial and inflammatory involvement as the main causes of the mechanisms leading to nephropathy and clinical complications. Future perspectives comprise establishing long-term cohort groups to assess the development of kidney disease and the patients' survival, as well as the use of new biomarkers such as urinary exosomes to detect risk groups and to understand the progression of kidney injuries.

Leprosy nephropathy: a review of clinical and histopathological features.

Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

Leprosy nephroptthy: a review of clinical and histopathological features / Nefropatia da hanseníase: revisão dos aspectos clínicos e histopatológicos

Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

A hanseníase é doença crônica causada pelo Mycobacterium leprae, altamente incapacitante e com envolvimento sistêmico em alguns casos. O envolvimento renal tem sido relatado em todas as formas da doença, sendo mais frequente nas formas multibacilares. A apresentação clínica é variável e determinada pela reação do sistema imunológico do hospedeiro ao bacilo. Durante o curso da doença podem ocorrer os chamados estados reacionais, nos quais o sistema imune reage contra o bacilo, exacerbando as manifestações clínicas. Diferentes lesões renais tem sido descritas na hanseníase, incluindo glomerulonefrites, nefrite intersticial, amiloidose secundária e pielonefrite. O mecanismo exato que leva à glomerulonefrite na hanseníase ainda não está completamente esclarecido. O tratamento da hanseníase inclui o uso de rifampicina, dapsona e clofazimina. Prednisona e antiinflamatórios não-hormonais podem ser usados no controle dos episódios imunológicos agudos.

Tropical diseases-associated kidney injury / Lesão renal associada a doenças tropicais

BACKGROUND AND OBJECTIVES: Infectious and parasitic diseases are important morbidity factors and mortality causes, accounting for more than 13 million deaths a year-one in two deaths in developing countries. Despite health providing expansion throughout, large populations are still at risk in many areas of Asia, Middle East, Africa and Americas. Tuberculosis, specially, poses new challenges, as nearly two billion people may have latent disease. Malaria kills over one million people a year - most of them young children. Most malaria deaths occur in Africa, where it accounts for one in five of all childhood deaths - women are especially vulnerable during pregnancy. Many of these illnesses may be accompanied by acute or chronic kidney involvement.CONTENTS: Acute kidney injury (AKI) and tubulointerstitial defects are frequently observed in the course of leptospirosis, malaria, and the several viral hemorrhagic fevers. All known varieties of glomerular lesions have been observed, with clinical presentations ranging from mild proteinuria or hematuria, to nephrotics yndrome. Tubular dysfunction may also occur, particularly in visceral leishmaniasis and leprosy, where distal tubular acidosis may be an early clinical expression of the disease. CONCLUSION: To summarize, almost every known infectious and parasitic disease may present with kidney involvement, varying from mild to extreme, and additionally burdening usually overwhelmed health services.

JUSTIFICATIVA E OBJETIVOS: As doenças infecciosas eparasitárias são fatores importantes de morbidade e causas demortalidade, sendo responsáveis por mais de 13 milhões demortes por ano - uma em cada duas mortes em países em desenvolvimento.Apesar da expansão do atendimento de saúdeem todos os locais, grandes populações ainda estão em riscoem muitas áreas da Ásia, Oriente Médio, África e Américas. Atuberculose, em especial, apresenta novos desafios, já que quasedois bilhões de pessoas podem ter uma doença latente. Amalária mata mais de um milhão de pessoas por ano - a maioriadelas crianças. A maioria das mortes por malária ocorre naÁfrica, onde é responsável por uma em cada cinco mortes decrianças - as mulheres são especialmente vulneráveis durante agravidez. Muitas destas doenças podem ser acompanhadas poracometimento renal agudo ou crônico.CONTEÚDO: A lesão renal aguda (LRA) e os defeitos túbulo--intersticiais são frequentemente observados no curso de leptospirose,malária, e de várias febres hemorrágicas virais. Todas asvariedades conhecidas de lesões glomerulares foram observadas,com apresentações clínicas que variam de ligeira proteinúria ouhematúria até síndrome nefrótica. Também pode ocorrer disfunçãotubular, especialmente na leishmaniose visceral e na lepra,onde a acidose tubular distal pode ser uma manifestação clínicaprecoce da doença.CONCLUSÃO: Em resumo, quase todas as doenças infecciosas eparasitárias conhecidas podem apresentar comprometimento renal,variando de leve a extremo e, sobrecarregando ainda mais osserviços de saúde geralmente já sobrecarregados.

[Amyloidosis and end-stage renal disease associated with leprosy]. / Amiloidose e insuficiência renal crônica terminal associada à hanseníase.

Renal involvement in leprosy includes glomerulonephritis, amyloidosis and tubulointerstitial nephritis. A 58-year-old man was admitted with complaints of lower limb edema and dyspnea. At admission, nitrogen retention, anemia, hyperkalemia and metabolic acidosis were observed, requiring hemodialysis. The patient had a history of lepromatous leprosy. A renal biopsy was performed that was compatible with amyloidosis. The patient had a stable outcome, but without renal function recovery and remained on regular hemodialysis. Leprosy should be investigated in every patient with renal function loss, particularly in those with cutaneous lesions or other manifestations suggestive of leprosy.

Amiloidose e insuficiência renal crônica terminal associada à hanseníase / Amyloidosis and end-stage renal disease associated with leprosy

O envolvimento renal na hanseníase é diverso, incluindo glomerulonefrites, amiloidose e nefrite túbulo-intersticial. Um homem de 58 anos foi admitido com edema de membros inferiores e dispnéia. Na admissão, havia retenção de escórias nitrogenadas, anemia, hipercalemia e acidose metabólica, com necessidade de hemodiálise. Referia história de hanseníase virchoviana. Foi realizada biopsia renal, compatível com amiloidose. O paciente evoluiu estável, sem recuperação da função renal, permanecendo em tratamento hemodialítico. A hanseníase deve ser investigada em todo paciente com perda de função renal, sobretudo naqueles que apresentam lesões cutâneas ou outras manifestações sugestivas de hanseníase.

Renal involvement in leprosy includes glomerulonephritis, amyloidosis and tubulointerstitial nephritis. A 58-year-old man was admitted with complaints of lower limb edema and dyspnea. At admission, nitrogen retention, anemia, hyperkalemia and metabolic acidosis were observed, requiring hemodialysis. The patient had a history of lepromatous leprosy. A renal biopsy was performed that was compatible with amyloidosis. The patient had a stable outcome, but without renal function recovery and remained on regular hemodialysis. Leprosy should be investigated in every patient with renal function loss, particularly in those with cutaneous lesions or other manifestations suggestive of leprosy.

Renal involvement in leprosy: retrospective analysis of 461 cases in Brazil

BACKGROUND: Renal lesions in leprosy have been extensively described, including amyloidosis, glomerulonephritis, nephrosclerosis, tubulointerstitial nephritis and granulomas. MATERIAL AND METHODS: A retrospective study was designed to detect renal function abnormalities in 461 leprosy patients, without any co-morbidity, seen in a university hospital in northeast Brazil. The laboratory test results concerning renal function were examined in the patients' medical records. RESULTS: The mean age was 39 ± 18 years and 217 (47 percent) were male. The mean duration of disease was 21 ± 38 months. Levels of creatinine above 1.4mg/dL had been detected in 40 patients (8.6 percent). The levels of creatinine and urea were higher in lepromatous leprosy patients. Proteinuria, hematuria and hemoglobinuria were significantly more frequent in this presentation of leprosy. Nephrotic levels of proteinuria (>3.5mg/dL) were found in three (2.1 percent) of 138 lepromatous leprosy patients. A positive association was found between duration of disease and high levels of creatinine in the general sample and in the lepromatous leprosy patients. There was no association between time of treatment and high levels of creatinine. CONCLUSION: Renal involvement in leprosy seems to be related to the quantity of bacilli present in the body. It is important to evaluate the renal function in all leprosy patients in order to detect any abnormality and prevent renal failure, which is still a potential cause of death in this disease.