[Involvement of the renal function in patients with visceral leishmaniasis (kala-azar)]. / Envolvimento da função renal em pacientes com leishmaniose visceral (calazar).

UNLABELLED: Evaluation of the renal involvement of visceral leishmaniasis (kala-azar) aiming at verifying clinical and laboratorial repercussions of the renal implication on VL. Laboratory analysis was performed of blood and urine samples collected immediately after confirming diagnosis through the finding of Leishmania in bone marrow. Two (18.1%) patient presented complications associated with kala-azar. Five patients (45.4%) presented macroscopic hematuria and one case (N 9) clinical manifestations compatible with an acute nephritis syndrome. Laboratorial data of urine exam showed: proteinuria in 10 (90.9%) patients, hematuria in 7 (63.6%) and leukocyturia in 6 (54.5%) cases. Nine (81.8%) patients presented high levels of microalbuminuria, characterizing glomerular lesion. The presence of proximal tubulopathy, measured through retinol binding protein observed in 5 (45.4%) cases. CONCLUSION: renal involvement was manifested in most subjects, contributing to the severity of the disease.

Envolvimento da função renal em pacientes com leishmaniose visceral (calazar) / Involvement of the renal function in patients with visceral leishmaniasis (kala-azar)

Envolvimento da funçäo renal em pacientes com leishmaniose visceral (calazar). Apresenta-se estudo prospectivo de 11 pacientes com LV, com o intuito de verificar as repercussöes clínico-laboratoriais da funçäo renal na doença. Realizou-se análises laboratoriais das amostras de sangue e urina, colhidas logo após confirmaçäo diagnóstica, através do encontro de leishmanias no aspirado de médula óssea. Dois (18 por cento) pacientes apresentaram complicaçöes associadas a LV. Cinco (45,4 por cento) apresentaram hematúria macroscópica e em um caso (No.9) manifestaçöes clínicas compatíveis com síndrome nefrítica aguda. Os resultados dos exames de urina mostraram: proteinúria em 10 (90,9 por cento) pacientes, hematúria 7 (63,6 por cento) e leucocitúria em 6 (54,5 por cento) casos. Nove (81,8 por cento) pacientes apresentaram níveis elevados de microalbuminúria caracterizando lesäo glomerular. A presença de tubulopatia proximal medida através da proteína ligadora de retinol, foi observada em 5 (45,4 por cento) casos. Concluiu-se que o envolvimento renal se fez presente na maioria dos pacientes, contribuindo para a gravidade da doença

Indirect assessment of eosinophiluria in urinary schistosomiasis using eosinophil cationic protein (ECP) and eosinophil protein X (EPX).

The pre- and post-treatment level of eosinophiluria, as measured indirectly by the amount of free or cell bound eosinophil cationic protein (ECP) and eosinophil protein X (EPX) in urine from Schistosoma haematobium-infected Kenyan school children, were measured and compared with intensity of infection (eggs/10 ml of urine), albuminuria and pathological changes as detected by ultrasonography. ECP and EPX were determined by means of specific ELISA methods and levels were determined in both urine supernatants and extracted urine deposits (cells and cell debris). The level of ECP was significantly raised in urine supernatants from infected children compared to controls, whereas high amounts of EPX were found in urine supernatants from infected children as well as from controls. However, the amounts of cell bound ECP and EPX were significantly raised in infected children. In pre-treatment observations significant correlations were demonstrated between egg counts, albuminuria and eosinophiluria as measured by the amount of cell bound ECP and EPX, or ECP in urine supernatants. No such correlations were demonstrated with the amount of EPX in the urine supernatants. Comparable amounts of ECP and EPX could be extracted from the urine deposits from infected children, but due to the high amounts of EPX in urine deposit extracts from controls, extracted ECP gave the best discrimination between infected and non-infected children. While albuminuria disappeared in most children at the 6 week post-treatment follow-up, eosinophiluria persisted in a significant proportion of the treated children indicating continued eosinophil activity in the bladder wall. Detection and quantification of early acute inflammatory reactions using ECP/eosinophils in combination with detection of later stages of bladder pathology using ultrasound may allow for a dynamic evaluation of the pathological process, the morbidity development and post treatment pathological changes in S. haematobium infections.

Measures of capillary permeability in acute falciparum malaria: relation to severity of infection and treatment.

Capillary permeability was investigated in 32 Thai patients aged 14-49 years who had acute falciparum malaria with use of three distinct techniques: quantitation of the urinary albumin/creatinine ratio (ACR), estimation of the transcapillary escape rate of radiolabeled albumin (TER), and retinal photography/fluorescein angiography. Fourteen patients had uncomplicated infections and 18 were severe cases. The severely ill patients had significantly higher ACRs (median, 4.8 mg/mmol; 95% confidence limits, 2.4-19.9 mg/mmol) and TERs (median, 8.3%/h; 95% confidence limits, 6.2-13.2%/h) than the uncomplicated cases (ACR: median, 2.1 mg/mmol; 95% confidence limits, 6.2-13.2%/h) than the uncomplicated cases (ACR: median, 2.1 mg/mmol; 95% confidence limits, 1.0-8.8 mg/mmol; TER: median, 5.9%/h; 95% confidence limits, 3.8-10.6%/h; P = .014 and .042). Both variables were significantly associated with biochemical indices of disease severity including total serum bilirubin levels (rs greater than or equal to 0.398, P less than .025 in each case), but there were no significant differences between ACRs and TERs among comatose and noncomatose patients with severe infections (P greater than or equal to .08). Retinopathy (hemorrhages, cotton-wool spots, capillary nonperfusion, and/or extravasation of fluorescein) was found in eight severely ill patients and in two uncomplicated cases. Fluorescein leakage was evident in six patients. Although fluorescein leakage had the strongest parametric correlation with the presence of coma relative to both ACR and TER in the full patient series (r = 0.58, P less than .01), multiple linear regression analysis indicated that concentrations of plasma lactate (t = 2.998, P = .006) and serum creatinine (t = 2.200, P = .036) were the factors responsible for this association. These data do not support a role for tissue edema in the pathogenesis of cerebral malaria but reveal an association between markers of disease severity and a generalized increase in systemic capillary permeability.