Leprosy-associated renal disease: case report and review of the literature.

Leprosy is an infectious disease the principal clinical manifestations of which are anesthetic skin lesions and the development of peripheral neuropathy. The most common renal manifestation in leprosy patients is glomerulonephritis. Both immunofluorescent and electron microscopic studies suggest that the varied glomerular lesions found in these patients are immune complex mediated. Other renal lesions that have been described include amyloidosis, tubulointerstitial disease, acute renal failure, and functional defects in the absence of identifiable histologic abnormalities. In this report, a patient is described who developed the clinical syndrome of rapidly progressive glomerulonephritis. The renal biopsy showed a diffuse endocapillary proliferative process with electron-dense deposits in the glomerular subendothelial and subepithelial spaces. Organisms consistent with Mycobacterium leprae were identified within several of the glomeruli.

Leptospiral antigens (L. interrogans serogroup ictero-haemorrhagiae) in the kidney of experimentally infected guinea pigs and their relation to the pathogenesis of the renal injury.

The search for leptospiral antigens (L. interrogans serogroup icterohaemorrhagiae) was carried out in 24 guinea pigs experimentally inoculated with 1 ml of culture containing 10(7)-10(8) leprospires and sequentially sacrificed from the first until the 6th day of infection. Semiquantitative analysis of histopathological variables comprising kidney interstitium, tubules and glomeruli was done in 1 micron sections of tissue embedded in glycolmetacrylate. Leptospiral antigen (LAg) and its glycolipoprotein (GLP) expression were detected through PAP in paraffin embedded tissue. The mild interstitial involvement of the kidney, manifested chiefly by oedema and focal interstitial nephritis seen at the 4th day, progressed to tubular damage at the 6th day, characterized by either swelling or cytoplasmic acidophilia of epithelial cells with loss of cell cohesion and sloughing of cells into the tubular lumina. Brush border alterations and mitochondrial changes were observed. Endothelial cell injury was noted in the interstitial vessels. LAg expression was parallel to the kidney changes: small deposits of elongated forms of LAg were detected at the 4th day either within the vascular lumen or free in the interstitium. A rise in the antigen expression was observed at the 5th day when it was seen either around tubules or in their walls. LAg was detected inside the tubular lumina at the 6th day of infection when granular LAg and GLP were abundant. This sequence reproduces the pathway of leptospires in the kidney and the crescent amounts of antigens detected toward the end of the experiment, with antigen concentration in cases of major tissue damage suggesting a direct action of the microorganisms and/or their products in the pathogesis of the lesions.