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Sousa MS, Meneses GC, van Dam GJ, Corstjens PLAM, Galvão RLDF, Pinheiro MCC, Martins AMC, Daher EDF, Bezerra FSDM. Subclinical signs of podocyte injury associated with Circulating Anodic Antigen (CAA) in Schistosoma mansoni-infected patients in Brazil. Rev Soc Bras Med Trop 2023; 56:e0341. [PMID: 36820657 PMCID: PMC9957141 DOI: 10.1590/0037-8682-0341-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/22/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The long-term effects of schistosomiasis on the glomerulus may contribute to the development of chronic kidney disease. This study aimed to investigate baseline Schistosoma mansoni-Circulating Anodic Antigen (CAA) levels and their association with kidney biomarkers related to podocyte injury and inflammation in long-term follow-up after praziquantel (PZQ) treatment. METHODS Schistosoma infection was diagnosed by detecting CAA in urine using a quantitative assay based on lateral flow using luminescent up-converting phosphor reporter particles. A cutoff threshold of 0.1 pg/mL CAA was used to diagnose Schistosoma infection (baseline) in a low-prevalence area in Ceará, Northeast, Brazil. Two groups were included: CAA-positive and CAA-negative individuals, both of which received a single dose of PZQ at baseline. Urinary samples from 55 individuals were evaluated before (baseline) and at 1, 2, and 3 years after PZQ treatment. At all time points, kidney biomarkers were quantified in urine and adjusted for urinary creatinine levels. RESULTS CAA-positive patients had increased baseline albuminuria and proteinuria and showed greater associations between kidney biomarkers. CAA levels correlated only with Vascular Endothelial Growth Factor (VEGF) (podocyte injury) levels. Increasing trends were observed for malondialdehyde (oxidative stress), monocyte chemoattractant protein-1 (inflammation marker), and VEGF. In the follow-up analysis, no relevant differences were observed in kidney biomarkers between the groups and different periods. CONCLUSIONS S. mansoni-infected individuals presented subclinical signs of glomerular damage that may reflect podocyte injury. However, no causal effect on long-term renal function was observed after PZQ treatment.
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Affiliation(s)
- Mariana Silva Sousa
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil.
| | - Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil.
| | - Govert Jan van Dam
- Leiden University Medical Centre, Department of Parasitology, Leiden, The Netherlands.
| | | | - Rosangela Lima de Freitas Galvão
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Patologia, Fortaleza, CE, Brasil.
| | - Marta Cristhiany Cunha Pinheiro
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil.
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Farmacêuticas, Fortaleza, CE, Brasil.
| | - Elizabeth de Francesco Daher
- Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil.
| | - Fernando Schemelzer de Moraes Bezerra
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Patologia, Fortaleza, CE, Brasil.
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Abstract
Parasitic agents have been known to cause human disease since ancient times and are endemic in tropical and subtropical regions. Complications of parasitic diseases, including kidney involvement, are associated with worse outcomes. Chagas disease, filariasis, leishmaniasis, malaria and schistosomiasis are important parasitic diseases that can damage the kidney. These diseases affect millions of people worldwide, primarily in Africa, Asia and Latin America, and kidney involvement is associated with increased mortality. The most common kidney complications of parasitic diseases are acute kidney injury, glomerulonephritis and tubular dysfunction. The mechanisms that underlie parasitic disease-associated kidney injury include direct parasite damage; immunological phenomena, including immune complex deposition and inflammation; and systemic manifestations such as haemolysis, haemorrhage and rhabdomyolysis. In addition, use of nephrotoxic drugs to treat parasitic infections is associated with acute kidney injury. Early diagnosis of kidney involvement and adequate management is crucial to prevent progression of kidney disease and optimize patient recovery.
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Liao ZN, Tao LJ, Yin HL, Xiao XC, Lei MX, Peng ZZ. Schistosoma japonicum infection associated with membranous nephropathy: a case report. BMC Infect Dis 2022; 22:125. [PMID: 35123391 PMCID: PMC8818173 DOI: 10.1186/s12879-022-07092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Schistosomiasis is one of the most contagious parasitic diseases affecting humans; however, glomerular injury is a rare complication mainly described with Schistosoma mansoni infection. We report a case of membranous nephropathy associated with Schistosoma japonicum infection in a Chinese man. Case presentation A 51-year-old Chinese male with a long history of S. japonicum infection presented to the hospital with a slowly progressing severe lower limb edema and foaming urine for over 5 months. Serum S. japonicumantigen test was positive and immunohistochemistry showed that the glomeruli were positive for the antigens. The renal pathologic diagnosis was stage III membranous nephropathy. The patient was treated with glucocorticoid, praziquantel, and an angiotensin-converting enzyme inhibitor. The edema in both lower limbs disappeared within 2 weeks, but his renal function declined progressively and proteinuria persisted after 5 months of therapy. Conclusions Different classes of schistosomal glomerulopathy have completely different clinical manifestation and prognosis. Therefore, efforts should focus on alleviating symptoms, prevention, and early detection. S. japonicumassociated with membranous nephropathy may show a good curative effect and prognosis. However, it is necessary to monitor the renal function in such patients.
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Neves PD, Bridi RA, Ramalho JA, Jorge LB, Watanabe EH, Watanabe A, Yu L, Woronik V, Pinheiro RB, Testagrossa LA, Cavalcante LB, Malheiros DM, Dias CB, Onuchic LF. Schistosoma mansoni infection as a trigger to collapsing glomerulopathy in a patient with high-risk APOL1 genotype. PLoS Negl Trop Dis 2020; 14:e0008582. [PMID: 33119586 PMCID: PMC7595310 DOI: 10.1371/journal.pntd.0008582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Schistosoma mansoni schistosomiasis (SM) remains a public health problem in Brazil. Renal involvement is classically manifested as a glomerulopathy, most often membranoproliferative glomerulonephritis or focal and segmental glomerulosclerosis. We report a case of collapsing glomerulopathy (CG) associated with SM and high-risk APOL1 genotype (HRG). Case report A 35-year-old male was admitted for hypertension and an eight-month history of lower-limb edema, foamy urine, and increased abdominal girth. He had a recent diagnosis of hepatosplenic SM, treated with praziquantel, without clinical improvement. Laboratory tests revealed serum creatinine 1.89mg/dL, blood urea nitrogen (BUN) 24mg/dL, albumin 1.9g/dL, cholesterol 531mg/dL, low-density lipoprotein 426mg/dL, platelets 115000/mm3, normal C3/C4, antinuclear antibody (ANA), rheumatoid factor (RF), and antineutrophil cytoplasmic antibodies (ANCA), negative serologies for hepatitis C virus (HCV) and human immunodeficiency virus (HIV), HBsAg negative and AntiHBc IgG positive, no hematuria or leukocyturia, 24 hour proteinuria 6.56g and negative serum and urinary immunofixation. Kidney biopsy established the diagnosis of CG. A treatment with prednisone was started without therapeutic response, progressing to end-stage kidney disease 19 months later. Molecular genetics investigation revealed an HRG. Conclusions This is the first report of CG associated with SM in the setting of an HRG. This case highlights the two-hit model as a mechanism for CG pathogenesis, where the high-risk APOL1 genotype exerts a susceptibility role and SM infection serves as a trigger to CG. Schistosomiasis mansoni is still a public health problem in Brazil and renal involvement is described. In such cases, a glomerulopathy is the typical manifestation, most often membranoproliferative glomerulonephritis. In the current article, we report a patient with a recent diagnosis of hepatosplenic SM who was admitted for nephrotic syndrome associated with reduced renal function and hypertension. Kidney biopsy established the diagnosis of collapsing glomerulopathy (CG) and molecular genetics investigation identified a high-risk APOL1 genotype (HRG). Of note, HRG has been associated with increased risk to develop CG, and a two-hit model has been proposed for the genesis of this glomerulopathy. According to this model, a HRG represents the increased-susceptibility component, while an infection or other environmental factors could act as triggers for the development of CG. Based on those data and model, our case raises SM infection as a new trigger for this severe form of glomerulopathy. This is the first description of a case of CG associated with SM in a patient with an HRG. This case corroborates the interactive role between genetic and environmental factors in the pathogenesis of CG but also identifies SM infection as an additional trigger for its development.
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Affiliation(s)
- Precil D. Neves
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
- Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ramaiane A. Bridi
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Janaína A. Ramalho
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lectícia B. Jorge
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Elieser H. Watanabe
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
- Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Andreia Watanabe
- Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luis Yu
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Viktoria Woronik
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rafaela B. Pinheiro
- Division of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Lívia B. Cavalcante
- Division of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Denise M. Malheiros
- Division of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Cristiane B. Dias
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luiz F. Onuchic
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
- Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- * E-mail:
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Pallangyo P, Bhalia S, Simelane NN, Lyimo F, Swai HJ, Mkojera ZS, Hemed NR, Misidai N, Millinga J, Janabi M. Massive Bilateral Hydroureteronephrosis and End-Stage Renal Disease Ensuing From Chronic Schistosomiasis: A Case Report. J Investig Med High Impact Case Rep 2020; 8:2324709620910912. [PMID: 32131640 PMCID: PMC7059228 DOI: 10.1177/2324709620910912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Globally, schistosomal infections affect over 200 million people resulting in the loss of 70 million disability-adjusted life years. In the sub-Saharan Africa region, where over 85% of the global schistosomal infections are found, it is estimated that about 120 million people become symptomatic, over 20 million have severe disease, and nearly 200 000 die every year. Renal impairment is a severe consequence of schistosomiasis occurring in about 6% of all infected individuals and in 15% of those with the hepatosplenic form. We present a case of massive bilateral hydroureteronephrosis and end-stage renal disease resulting from chronic schistosomiasis in a 38-year-old male of African origin. A 38-year-old male rice farmer of African origin presented with a history of elevated blood pressure, abdominal swelling, and reduced urinary output for about 10 months. Abdominal examination revealed an intraabdominal mass measuring 30 cm × 17 cm extending from the right hypochrondrium region downward to right inguinal outward to umbilicus crossing the midline. He had an estimated glomerular filtration rate of 3.9 mL/min, hemoglobin of 6.78 g/dL, and had multiple electrolyte abnormalities. A computed tomography intravenous urogram scan of the abdomen revealed hepatomegaly (18 cm), bilateral renal enlargement with hydroureteronephrosis, and multiple calcifications on the urinary bladder. A rectal biopsy isolated haematobium eggs and confirmed the diagnosis. Urinary schistosomiasis can have distressing effects on the urinary system in particular and survival prospects in general. In view of this, extensive evaluation of the genitourinary system is pivotal for timely diagnosis and prompt management particularly in residents of schistosoma-endemic communities presenting with obstructive uropathy.
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Affiliation(s)
| | - Smita Bhalia
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | | | | | | | | | | | | | | | - Mohamed Janabi
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Eid RA, Al-Shraim M, El-Sayed F, Radad K. Ultrastructural changes of kidney in Schistosoma mansoni-infected mice. Ultrastruct Pathol 2017; 41:320-326. [DOI: 10.1080/01913123.2017.1349851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Refaat A. Eid
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Fahmy El-Sayed
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Khaled Radad
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Immune complexes in chronic Chagas disease patients are formed by exovesicles from Trypanosoma cruzi carrying the conserved MASP N-terminal region. Sci Rep 2017; 7:44451. [PMID: 28294160 PMCID: PMC5353755 DOI: 10.1038/srep44451] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/08/2017] [Indexed: 01/08/2023] Open
Abstract
The exovesicles (EVs) are involved in pathologic host-parasite immune associations and have been recently used as biomarkers for diagnosis of infectious diseases. The release of EVs by Trypanosoma cruzi, the causative agent of Chagas disease, has recently been described, with different protein cargoes including the MASP multigene family of proteins MASPs are specific to this parasite and characterized by a conserved C-terminal (C-term) region and an N-terminal codifying for a signal peptide (SP). In this investigation, we identified immature MASP proteins containing the MASP SP in EVs secreted by the infective forms of the parasite. Those EVs are responsible for the formation of immune complexes (ICs) containing anti-MASP SP IgGs in patients with different (cardiac, digestive and asymptomatic) chronic Chagas disease manifestations. Moreover, purified EVs as well as the MASP SP inhibit the action of the complement system and also show a significant association with the humoral response in patients with digestive pathologies. These findings reveal a new route for the secretion of MASP proteins in T. cruzi, which uses EVs as vehicles for immature and misfolded proteins, forming circulating immune complexes. Such complexes could be used in the prognosis of digestive pathologies of clinical forms of Chagas disease.
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Mpondo BCT, Neilson E, Ernest A. Prevalence of chronic kidney disease in diabetic adult out-patients in Tanzania. BMC Nephrol 2016; 17:71. [PMID: 27391318 PMCID: PMC4938949 DOI: 10.1186/s12882-016-0276-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/16/2016] [Indexed: 11/25/2022] Open
Abstract
Despite the increasing number of patients with Diabetes Mellitus in sub-Saharan Africa, the magnitude of chronic kidney disease among diabetics has not been well established. A study done by Janmohamed et al. found chronic kidney disease in 83.7 % of diabetics which is relatively higher than the prevalence reported elsewhere. However this study was conducted in schistosoma endemic area along the shores of Lake Victoria. Schistosomiasis has been reported to cause a range of renal diseases. Interpretation of these findings should therefore take into account the possibility of schistosomiasis as a possible confounder.
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Affiliation(s)
- Bonaventura C T Mpondo
- Department of Internal Medicine, School of Medicine and Dentistry, College of Health and Allied Sciences, The University of Dodoma, Dodoma, Tanzania.
| | - Eric Neilson
- Peace Corps/SEED Global Health Service Partnership, Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - Alex Ernest
- Department of Surgery and Maternal Health, School of Medicine and Dentistry, College of Health and Allied Sciences, The University of Dodoma, Dodoma, Tanzania
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Queiroz AL, Barreto DMS, da Silva GB, Tavares JEDS, Costa FI, Patrocínio RMDSV, Daher EDF, de Almeida PRC. Pattern, clinical features and response to corticoids of glomerular diseases in a Brazilian population. An analytical cross-sectional study. SAO PAULO MED J 2015; 133:43-50. [PMID: 25424774 PMCID: PMC10496615 DOI: 10.1590/1516-3180.2013.7360006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 06/18/2013] [Accepted: 01/29/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Glomerular disease registries are increasing all around the world. The aim of this study was to evaluate the clinical characteristics and treatment response among patients with glomerular diseases followed up in a tertiary hospital in Brazil. DESIGN AND SETTING Analytical cross-sectional study; tertiary-level public hospital. METHODS This study included patients with glomerular diseases followed up at a tertiary hospital in Fortaleza, northeastern Brazil. Clinical and laboratory data on each patient were registered. The response to specific treatment was evaluated after 3, 6 and 12 months. RESULTS The study included 168 patients of mean age 37 ± 14 years. The most prevalent glomerular diseases were focal segmental glomerulosclerosis FSGS] (19.6%), minimal change disease MCD] (17.9%), membranous nephropathy MN] (16.7%) and lupus nephritis LN] (11.9%). The main clinical presentations were nephrotic proteinuria (67.3%) and renal insufficiency (17.9%). The mean proteinuria value decreased after the treatment began. Regarding 24-hour proteinuria on admission, there was no significant difference between patients with a good response and those with no response (7,448 ± 5,056 versus 6,448 ± 4,251 mg/24 h, P = 0.29). The glomerular disease with the highest remission rate was MCD (92%). Absence of interstitial fibrosis presented a strong correlation with remission (remission in patients without fibrosis = 83.4% versus 16.3% in those with fibrosis, P = 0.001). CONCLUSIONS The present study found that the most frequent glomerular disease was FSGS, followed by MCD, MN and LN. The presence of interstitial fibrosis was a predictor of poor therapeutic response.
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Affiliation(s)
- Anaiara Lucena Queiroz
- MD, Postgraduate Pathology Program, Universidade Federal do Ceará (UFCE), Fortaleza, Ceará, Brazil.
| | - Dulce Maria Sousa Barreto
- MD. Nephrologist and Attending Physician, Division of Nephrology, Hospital Geral de Fortaleza (HGF), Fortaleza, Ceará, Brazil.
| | - Geraldo Bezerra da Silva
- MD, PhD. Adjunct Professor in the Medicine Course and Post-Graduation Program in Collective Health, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil.
| | - José Edísio da Silva Tavares
- MD. Attending Physician, Department of Internal Medicine, Universidade Federal do Ceará (UFCE), Fortaleza, Ceará, Brazil.
| | - Francisco Israel Costa
- MD. Attending Physician, Department of Internal Medicine, Universidade Federal do Ceará (UFCE), Fortaleza, Ceará, Brazil.
| | | | - Elizabeth De Francesco Daher
- MD, PhD. Adjunct Professor, Department of Internal Medicine, Universidade Federal do Ceará (UFCE), Fortaleza, Ceará, Brazil.
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Duarte DB, Vanderlei LA, de Azevêdo Bispo RK, Pinheiro ME, da Silva Junior GB, Martins AMC, Meneses GC, De Francesco Daher E. Renal function in hepatosplenic schistosomiasis--an assessment of renal tubular disorders. PLoS One 2014; 9:e115197. [PMID: 25531759 PMCID: PMC4274079 DOI: 10.1371/journal.pone.0115197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/19/2014] [Indexed: 01/07/2023] Open
Abstract
Background Renal involvement in Schistosoma mansoni infection is not well studied. The aim of this study is to investigate the occurrence of renal abnormalities in patients with hepatosplenic schistosomiasis (HSS), especially renal tubular disorders. Methods This is a cross-sectional study with 20 consecutive patients with HSS followed in a medical center in Maceió, Alagoas, Brazil. Urinary acidification and concentration tests were performed using calcium chloride (CaCl2) after a 12-h period of water and food deprivation. The biomarker monocyte chemoattractant protein 1 (MCP-1) was quantified in urine. Fractional excretion of sodium (FENa+), transtubular potassium gradient (TTKG) and solute-free water reabsorption (TcH2O) were calculated. The HSS group was compared to a group of 17 healthy volunteers. Results Patients' mean age and gender were similar to controls. Urinary acidification deficit was found in 45% of HSS patients. Urinary osmolality was significantly lower in HSS patients (588±112 vs. 764±165 mOsm/kg, p = 0,001) after a 12-h period of water deprivation. TcH2O was lower in HSS patients (0.72±0.5 vs. 1.1±0.3, p = 0.04). Urinary concentration deficit was found in 85% of HSS patients. The values of MCP-1 were higher in HSS group than in control group (122±134 vs. 40±28 pg/mg-Cr, p = 0.01) and positively correlated with the values of microalbuminuria and proteinuria. Conclusions HSS is associated with important kidney dysfunction. The main abnormalities found were urinary concentrating ability and incomplete distal acidification defect, demonstrating the occurrence of tubular dysfunction. There was also an increase in urinary MCP-1, which appears to be a more sensitive marker of renal damage than urinary albumin excretion rate.
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Affiliation(s)
- Daniella Bezerra Duarte
- Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil
- Department of Internal Medicine, Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lucas Alexandre Vanderlei
- Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil
| | | | - Maria Eliete Pinheiro
- Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil
| | - Geraldo Bezerra da Silva Junior
- School of Medicine, Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, CE, Brazil
| | | | | | - Elizabeth De Francesco Daher
- Department of Internal Medicine, Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
- * E-mail:
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Abstract
Schistosomiasis is the second most common socio-economically devastating parasitic disease after malaria, affecting about 240 million residents of developing countries. In Africa, it predominantly manifests as urogenital disease, and the main infective agent is Schistosoma hematobium. Endemicity is propagated by poor socio-economic status and environmental degradation due to rapid urbanization. Recreational swimming is a potent medium for the spread of disease in children and adolescents. Most affected individuals are asymptomatic. The male and female worms are equipped with an extraordinary capacity for immune evasion and are able to co-habit for several decades within the pelvic venous plexus. Eggs deposited in the bladder wall resist elimination by type 1 T lymphocytes. Instead, they are sustained by pro-fibrogenic encapsulation (as modulated by type 2 helper cells). Progressive bladder disease results in obstructive uropathy and predisposes to (mostly) squamous cell carcinoma. Schistosomal glomerulopathy manifests as a clinical spectrum of asymptomatic proteinuria, nephrosis and/or nephritic syndrome. Findings on renal biopsy may be influenced by co-morbidity with Salmonella bacteria, amyloidosis and hepatitis C infection. Potentially fatal Katayama fever and spinal radiculopathy may ensue in tourists visiting an endemic zone. Early detection by urine microscopy is hampered by low urinary excretion rates of the parasite eggs. Although useful in travelers with newly acquired disease, the results of the serological antibody assay may be false positive in residents of an endemic zone. Cystoscopy, however, may be invaluable. Due to its safety, effectiveness and once-daily dosing, praziquantel is the drug of choice. An integrated approach that includes mass chemotherapy, environmental health programs and public health education is the most cost-effective preventive strategy.
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Affiliation(s)
- Oluwatoyin F Bamgbola
- Division of Pediatric Nephrology, Children's Hospital of New Orleans, Louisiana State University Health Science Center, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA,
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Rodriguez JY, Lewis BC, Snowden KF. Distribution and characterization of Heterobilharzia americana in dogs in Texas. Vet Parasitol 2014; 203:35-42. [PMID: 24746236 DOI: 10.1016/j.vetpar.2014.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 03/05/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
Heterobilharzia americana is a trematode parasite (family Schistosomatidae) that infects a wide range of wild mammalian hosts. Canine cases have been reported in the Gulf coast and south Atlantic states, Kansas, and Oklahoma. A total of 238 canine H. americana cases in Texas were retrospectively collected for a period of approximately 22 years from case records at the Texas Veterinary Medical Diagnostic Laboratory and the Veterinary Medical Teaching Hospital pathology service, diagnostic parasitology service, and Gastrointestinal Laboratory at Texas A&M University College of Veterinary Medicine. Of these cases, 26 patients had 1-2 repeat positive tests for a total of 268 positive tests (26 biopsies, 39 necropsies, 160 fecal examinations, and 43 PCR). Multiple dogs were infected in 12 households. Cases were distributed primarily in the eastern region of Texas in 42 of 254 counties. Cases were seen as far west as Kerr county and in counties bordering Oklahoma, Louisiana, Mexico, and the Gulf of Mexico. The median dog age was 5.6 years (2.7 months to 17.2 years) and the median weight was 20.5 kg (1-61.6 kg). All American Kennel Club (AKC) breed groups were represented (n=186): crossbred (20%), herding (17.8%), sporting (16.1%), toy (10.8%), hounds (10.8%), working (10.1%), terrier (8.5%), non-sporting (4.9%), and miscellaneous (1%). No seasonal pattern of diagnosis was apparent. Clinical signs reported (n=90) were diarrhea (67%), weight loss (38%), anorexia/hyporexia (27%), vomiting (22%), hematochezia (20%), lethargy (17%), polyuria/polydipsia (6%), and collapse (3%). In 39 necropsy cases, trematode eggs were identified by histopathology in the small intestine (84%), liver (84%), large intestine (39%), pancreas (35%), lung (9%), lymph node (8%), spleen (4%), and stomach (3%). Adult parasites were identified histologically in four cases. Granulomatous inflammation associated with the eggs was the most commonly reported histopathologic change. Other changes reported were fibrosis, pigment in macrophages, and organ mineralization. Glomerulonephritis was identified in four cases. Of 20 necropsy cases where death was attributable to H. americana infection, only one case was diagnosed ante mortem. Eleven of these dogs were examined by a veterinarian but H. americana was included as a differential diagnosis in only two cases. Reported differential diagnoses included ethylene glycol toxicity, cholecalciferol toxicity, lymphoma, and pancreatitis. These data indicate that this parasite is more widely distributed and more common than is generally recognized. Increased awareness may aid in more diagnoses and timely therapy.
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Affiliation(s)
- J Y Rodriguez
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4467 TAMU, College Station, TX 77843-4467, USA.
| | - B C Lewis
- Texas Veterinary Medical Diagnostic Laboratory, P.O. Drawer 3040, College Station, TX 77841-3040, USA
| | - K F Snowden
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4467 TAMU, College Station, TX 77843-4467, USA
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Renal parenchyma developmental plasticity in mice infected with Schistosoma mansoni, whose mothers were malnourished during lactation. Exp Parasitol 2013; 134:368-73. [PMID: 23567250 DOI: 10.1016/j.exppara.2013.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/24/2022]
Abstract
Effects of maternal malnutrition during lactation on the kidneys in mice infected with Schistosoma mansoni. Kidneys from programmed infected mice and their respective controls fed a normal diet (23% protein), a protein-restricted group (PR) (8% protein) and a caloric-restricted group (CR) (according to the PR group intake) evaluated by biometry, morphometry and histopathology. Both PR and CR groups showed a reduction in the number of glomeruli when compared with the control group (CR: -29% vs C; PR: -41% vs C; p<0.05) as well as infected mice (ICR: -32% vs IC; IPR: -47% vs IC; p<0.05). Among infected mice, ICR group showed higher kidney weights (+18% vs IC and +12% vs IPR; p<0.01). The ICR and IPR groups showed largest perimeter and area when compared to the corresponding uninfected group (ICR vs CR: +26%; IPR vs PR: +21%, p<0.05) and area (ICR vs CR: +95%; IPR vs PR: +50%, p<0.05). The ICR group showed an increase of within Bowman (CR vs ICR: +56%, p<0.05), whereas Bowman's space was reduced (PR vs IPR, -61%; p<0.05). Conclude that malnutrition during lactation programmed the metabolic state of the host, resulting in the evolution of the histology of the renal parenchyma.
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Tavares MB, Chagas de Almeida MDC, Martins RTC, de Sousa ACGP, Martinelli R, dos-Santos WLC. Acute tubular necrosis and renal failure in patients with glomerular disease. Ren Fail 2012; 34:1252-7. [PMID: 23002699 PMCID: PMC3496189 DOI: 10.3109/0886022x.2012.723582] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Renal failure is common in patients with glomerular disease. Although renal failure may result from the glomerular lesion itself, it is also observed in patients with minimal glomerular alterations. Degenerative changes and necrosis of the tubular epithelium are common findings in kidney biopsies from these patients. The aim of this work is to examine the association between acute tubular necrosis (ATN) and renal failure in patients with glomerulopathy and to estimate the relationship between the degree of ATN and renal failure in these patients. Data on age, sex, presence of nephrotic syndrome, and renal failure were recorded for 149 patients, who underwent a renal biopsy for the diagnosis of glomerulopathy. The biopsies were reviewed, and ATN, when present, was classified as one of four grades depending on its intensity. The mean age of the patients was 21 ± 16 years. Eighty patients (54%) were male, 43 (42%) had renal failure, 104 (72%) had nephrotic syndrome, and 66 (45%) had minimal change disease or focal segmental glomerulosclerosis. ATN was present in 115 (77%) patients. The frequency of renal failure was directly correlated with the intensity of ATN [odds ratio (OR) of 26.0 for patients with grade 2 lesions and OR of 45.5 for patients with grade 3 lesions]. ATN is a common finding in the biopsies of patients with glomerulopathy. The severity of ATN is directly associated with the frequency of renal failure in these patients.
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Affiliation(s)
- Maria Brandão Tavares
- Fundação Oswaldo Cruz, Centro de Pesquisa Gonçalo Moniz, Rua Waldemar Falcão, Candeal, Salvador, BA, Brazil
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