Kidney involvement in leishmaniasis—a review

Abstract

Leishmaniasis is an infectious disease caused by protozoa of the genus Leishmania transmitted by insects of the genus Lutzomyia sp. or Phlebotomus sp. The main syndromes are cutaneous leishmaniasis, mucocutaneous leishmaniasis, visceral leishmaniasis (kala-azar) and post-kala-azar dermal leishmaniasis. This article reviews kidney involvement in cutaneous and visceral leishmaniasis, highlighting the aspects of their pathophysiology, clinical manifestations, histopathological findings, outcome and treatment.

Visceral leishmaniasis‐associated nephropathy in hospitalised Brazilian patients: new insights based on kidney injury biomarkers

“…We observed higher proteinuria and albuminuria levels in VL patients. In VL, glomerular damage has been characterised as a mesangial proliferative lesion or deposition of immune complexes, leading to rapidly progressive glomerulonephritis . Elevated proteinuria can be a result of hypergammaglobulinemia in VL patients with low molecular weight protein fractions such as alpha 1, alpha 2, beta microglobulins and especially gamma globulins, which were freely filtrated in the glomeruli.…”

“…Thus we suggest that higher levels of systemic NGAL observed in our present VL patients may be associated with exacerbated and inefficient neutrophil activation, which contributes to the infection progression. On the other hand, intrinsic kidney injury resulting from VL infection and inflammation may contribute to increased NGAL expression in nephron segments, leading to a further increase in both urinary and systemic NGAL . Furthermore, any GFR impairment due to kidney injury contributes to a decrease in renal clearance of NGAL and, consequently, to an increase in NGAL circulation levels (Figure ).…”

“…In Brazil, VL is endemic with 3298 cases in 2015, being responsible for 272 deaths, with a lethality rate of almost 8% . VL‐associated nephropathy has been related with higher mortality in these patients .…”

Nephrotic syndrome in a patient with visceral leishmaniasis: a case report

“…Severe nephrotic range proteinuria in visceral leishmaniasis is reported only when associated with either HIV or amyloidosis [4]. Our patient was negative for HIV.…”

“…Histology specimens show tubulointerstitial, proliferative glomerulonephritis and proximal tubulopathy changes. Proteinuria in the range of 1-2g/24 hrs are reported in the literature, but excretion rates of more than 2g/24 hrs were not found in isolated cases of visceral leishmaniasis [3,4].…”