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Spectrum Of Renal Disease In Visceral Leishmaniasis

机译：内脏利什曼病的肾脏疾病谱

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Background: Renal involvement in Visceral Leishmaniasis has been reported in the form of proteinuria, microscopic haematuria, acute renal failure and histologic abnormalities in kidney biopsy. However, renal disease in Visceral Leishmaniasis is not widely documented from India, despite kala-azar being endemic in this country. Material methods: We have studied incidence and spectrum of clinical renal disease in patients with Visceral Leishmaniasis (VL). This study included 240 (Male: 154 and Female: 86) patients with parasitological confirmed diagnosis of VL over a period of two years (April 2002 – April 2004). The presence of oliguria, edema, proteinuria, elevated serum creatinine and haematuria either alone or in combination were taken as evidence of clinical renal disease. Renal tissue under light microscope was studied in six cases.Observation: The renal involvement was documented in 37/240 (15%) patients. The age (Male:32; Female:05) of the patient ranged between 15-36 years. The spectrum of renal diseases included; proteinuria in the range of 1-2 gm/day (15%), abnormal urinary sediment (4%), edema (9%) and acute renal failure (15%) of cases. Dialytic support was not needed. All patients received Amphotericin B (1.0 mg per kg body wt.) as anti-leishmanial treatment for 15 infusions. Renal histology in six patients revealed; ATN (4), AIN (01) and thrombotic microangiopathy in (01) patients. Glomerular lesions were not observed in our study. There was no mortality. Conclusion: Renal disease can occur during the course of Visceral Leishmaniasis. They were of mild nature and reversible with treatment of Kala-azar without specific treatment. Acute renal failure is mostly related to prerenal factors and overall renal disease carry good prognosis in patient with Visceral Leishmaniasis. Introduction Visceral leishmaniasis (VL) is a disseminated protozoal infection of reticuloendothelial system caused by Leishmania donovani and characterized by fever, hepatosplenomegaly, anaemia, leucopenia, thrombocytopenia and hyperglobulinemia (1). Renal involvement in the form of proteinuria (usually < 1gm/24hrs) and acute renal dysfunction have been reported in Indian patients with Kala-azar (2). Different patterns of renal histological lesions had been described in experimental animals (3, 4). Acute interstitial nephritis related to visceral leishmaniasis was described in autopsy study of 21 patients from Sao Paulo general hospital (5). Immune complex mediated glomerulonephritis was reported in patients with VL by other workers as well (6, 7). Visceral leishmaniasis causing graft dysfunction is reported in renal transplant recipient (8, 9). However, renal disease is not well documented from India, despite VL being endemic disease in eastern part of the country. We have studied incidence and spectrum of clinical renal disease in patients with VL at Kala-azar unit of our hospital. Material Methods This study was carried in the Department of Nephrology and Kala-azar unit of Institute of Medical Sciences, Banaras Hindu University, Varanasi, India between April 2002 to May 2004. Two hundred and forty (male: 154; female: 86) patients with parasitologically confirmed diagnosis of VL were included in the study. Diagnosis of Kala-azar was proved by demonstration of Leishmania Donovani (LD) bodies in bone marrow/spleenic aspirate. All patients were screened for the presence of clinical renal disease during the course of hospital stay. The presence of hematuria, proteinuria, edema, elevated serum creatinine and abnormal urine sediments were taken as evidence of clinical renal disease. The patients with VL and clinical renal disease were subjected to detailed physical examination and following laboratory tests were carried in all such cases; urinalysis for cells, casts and crystals, 24 hours urinary excretion of protein, serum creatinine, blood urea, serum protein and albumin, serum electrolyte, serum calcium, phosphorous, alkaline phosphatase, total and
机译：背景：已经报道了肾脏参与内脏利什曼病的形式为蛋白尿，镜下血尿，急性肾衰竭和肾活检组织学异常。然而，印度内脏利什曼病的肾脏疾病并未得到广泛报道，尽管该国普遍存在黑热病。材料方法：我们研究了内脏利什曼病（VL）患者的临床肾脏疾病的发生率和频谱。该研究包括240名（男性：154名，女性：86名）在两年内（2002年4月至2004年4月）被寄生虫病确诊为VL的患者。单独或联合存在尿少，水肿，蛋白尿，血清肌酐升高和血尿被视为临床肾脏疾病的证据。在光学显微镜下研究了6例肾组织。观察：37/240例（15％）患者的肾脏受累。患者的年龄（男性：32;女性：05）介于15-36岁之间。肾脏疾病的范围包括：蛋白尿的范围为1-2克/天（15％），尿沉渣异常（4％），水肿（9％）和急性肾衰竭（15％）。不需要透析支持。所有患者均接受两性霉素B（每公斤体重1.0 mg）作为抗利什曼治疗，共15次输注。六例患者的肾脏组织学表现; ATN（4），AIN（01）和（01）患者的血栓性微血管病。在我们的研究中未观察到肾小球病变。没有死亡。结论：内脏利什曼病可发生肾脏疾病。它们性质温和，未经特殊治疗可逆治黑热病。急性肾功能衰竭主要与肾前因素有关，内脏利什曼病患者的整体肾脏疾病预后良好。前言内脏利什曼病（VL）是一种由网状利什曼原虫引起的网状内皮系统的弥散性原生动物感染，其特征是发烧，肝脾肿大，贫血，白细胞减少症，血小板减少和高球蛋白血症（1）。在印度患有Kala-azar的患者中，已经报道了肾脏以蛋白尿形式出现（通常<1gm / 24hrs）和急性肾功能不全（2）。实验动物中已经描述了肾脏组织学病变的不同模式（3、4）。圣保罗总医院的21例患者的尸检研究中描述了与内脏利什曼病相关的急性间质性肾炎（5）。 VL患者中也有其他工人报道了免疫复合物介导的肾小球肾炎（6，7）。肾移植受者报道内脏利什曼病引起移植物功能障碍（8、9）。然而，尽管VL是该国东部地区的地方性疾病，但印度的肾脏疾病证据不足。我们已经在我们医院的卡拉-阿萨尔医院研究了VL患者的临床肾脏疾病的发病率和频谱。资料方法这项研究在2002年4月至2004年5月之间，在印度瓦拉纳西的Banaras印度大学的医学研究所的肾脏病学和Kala-azar部门进行。240例（男：154;女：86）患者寄生虫学证实为VL的诊断包括在研究中。通过在骨髓/脾脏抽吸物中显示利什曼原虫Donovani（LD）尸体证明了对Kala-azar的诊断。在住院期间对所有患者进行了临床肾脏疾病筛查。血尿，蛋白尿，水肿，血清肌酐升高和尿液沉积异常被视为临床肾脏疾病的证据。对所有患有VL和临床肾病的患者进行了详细的身体检查，并在所有这些情况下进行了实验室检查;对细胞，铸型和晶体进行尿液分析，24小时尿蛋白排泄，血清肌酐，血尿素，血清蛋白和白蛋白，血清电解质，血清钙，磷，碱性磷酸酶，总和

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