Amiloidose e insuficiência renal crônica terminal associada à hanseníase

Abstract

RESUMOO 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. Palavras-Chaves: Hanseníase. Insuficiência renal crônica. Amiloidose. ABSTRACTRenal 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.

Leprosy: a review of laboratory and therapeutic aspects - Part 2

“…Urinalysis should be performed with the purpose of seeking for changes in urinary concentration, leukocituria, proteinuria, and hematuria. 101 Testicular involvement may lead to decrease in testosterone levels and increase in plasma estradiol, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. Hyperprolactinemia may be related to hypogonadism and hyperestrogenemia.…”

Acute renal failure by rapidly progressive glomerulonephritis with IgA deposition in a patient concomitantly diagnosed with multibacillary Hansen's disease: a case report

“…6 The association between Hansen's and renal disease has been well documented in the literature in the form of manifestations of glomerulonephritis, tubulointerstitial disorders, and chronic kidney disease with secondary amyloidosis. 7 , 8 Renal impairment was found in 3.8% of the individuals enrolled in a large cohort study conducted by Daher et al ., with the following associated main risk factors: episodes of lepra reaction (erythema nodosum in particular), multibacillary disease, male gender, age, and time with the disease. Several urinary alterations have also been described (proteinuria in 4.8%; hematuria in 6.8%; leukocyturia in 10.4%).…”

Leprosy Nephropathy: A Review of Clinical and Histopathological Features

“…Interstitial nephritis was observed in 10 patients and amyloidosis in one case. Chronic kidney disease caused by secondary amyloidosis has also been described in leprosy 52 ( Fig. 2 ).…”

“…CHRONIC KIDNEY DISEASE: Chronic kidney disease (CKD) has been reported as one of the causes of death in leprosy, mainly in the first studies of leprosy nephropathy 5 , 28 , 36 , 43 , . CKD is mainly caused by amyloidosis and is also more frequent in the virchowian form 26 , 33 , 52 . It has also been reported in patients with the tuberculoid form 33 .…”