Leishmaniasis-Associated Membranoproliferative Glomerulonephritis With Massive Complement Deposition

Sethi, Sanjeev; Fervenza, Fernando C.; Siddiqui, Anila; Quint, Patrick; Pritt, Bobbi S.

doi:10.1016/j.ekir.2016.06.003

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…AKI is a clinical syndrome characterized by a sudden decrease in glomerular filtration rate (GFR) sufficient to decrease the elimination of nitrogenous waste products and other uremic toxins [ 11 ]. Possible causes of development of AKI in VL patients are multifactorial which include the disease itself, drug toxicity, presence of associated infections and hemodynamic abnormalities [ 8 , 12 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia

et al. 2021

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Background Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia. Methods A hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05. Results Among 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20–27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99–18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37–8.65, p = 0.009) to be independently associated with AKI. Conclusion AKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.

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Section: Introductionmentioning

confidence: 99%

Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia

et al. 2021

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“…Direct Leishmania -induced renal damage mainly results from immunological phenomena, such as the deposition of immune complexes, activation of T cells, up-regulation of adhesion molecules, inflammatory processes, but can also be caused by parasite proliferation in the kidney tissue [ 54 , 55 ] Beside VL, the other causes that can contribute to the development of renal damage in VL patients are drug toxicity, presence of associated infections and haemodynamic abnormalities [ 51 , 53 , 56 ]. Histological examination of graft biopsies in KT recipients with VL is seldom described (Table 1 ); findings range from the absence of parasites [ 39 ] to diffuse interstitial inflammation and abundant parasites [ 35 ] to complete occlusion of renal vasculature [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Updated diagnosis and graft involvement for visceral leishmaniasis in kidney transplant recipients: a case report and literature review

et al. 2022

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Purpose Visceral leishmaniasis (VL) has become a rising concern to transplantation teams, being associated with graft dysfunction and reduced survival of renal transplant recipients. Here, we describe a case of VL occurring in a kidney transplant (KT) recipient in Italy, a country in which Leishmania infantum is endemic and we reviewed the literature on the clinical course and diagnosis of VL in KT recipients residing or travelling to southern Europe. Results The VL case was diagnosed 18 months after transplant and 28 days after the onset of symptoms by quantitative PCR (qPCR) on peripheral blood. A graft biopsy showed renal involvement, and PCR performed on graft tissue displayed the presence of Leishmania DNA. The retrospective confirmation of Leishmania-positive serology in a serum sample collected before transplantation, as well as the absence of anti-Leishmania IgG in the graft donor strongly suggest that reactivation of a latent parasitic infection caused VL in the current case. Conclusion VL is often underdiagnosed in transplant recipients, despite the presence of latent Leishmania infection being reported in endemic countries. This case report, as well as the literature review on leishmaniasis in KT recipients, underline the importance of rapid VL diagnosis to promptly undergo treatment. Serology is scarcely sensitive in immunocompromised patients, thus molecular tests in peripheral blood should be implemented and standardized for both VL identification and follow-up.

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“…While high anti- Leishmania IgG titers have been correlated to mucosal leishmaniasis severity ( de Lima et al., 2021 ), a correlation between high levels of Leishmania -specific IgA and IgE seem to have contributed to more severe forms of American tegumentary leishmaniasis in the context of L. panamensis infection ( O’Neil et al., 1993 ). Likewise, abundant IgG and IgM, forming immune complexes with complement factors of the classical and terminal pathways, have been implicated in Leishmaniasis-Associated Membranoproliferative Glomerulonephritis ( Sethi et al., 2016 ). Furthermore, a case of L. infantum reactivation with secondary IgA nephropathy has recently been described ( Grewe et al., 2022 ).…”

Section: Prevalence Of Different Immunoglobulin Classes May Point To ...mentioning

confidence: 99%

Humoral response in Leishmaniasis

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Maciel

Assis

et al. 2022

Front. Cell. Infect. Microbiol.

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Leishmaniasis presents different types of clinical manifestations that can be divided into cutaneous leishmaniasis and visceral leishmaniasis. The host’s immune system, associated with genetic and nutritional factors, is strongly involved in the evolution of the disease or parasite escape. Humoral immunity is characterized by the production of antibodies capable of promoting neutralization, opsonization, and activation of the complement system. In this scenario, B lymphocytes produce antibodies that play an important role in Leishmania infection although neglected for a long time. Thus, relevant aspects in the establishment of Leishmania infection will be addressed, highlighting the importance of humoral immunity during the entire process of Leishmania infection.

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Leishmaniasis-Associated Membranoproliferative Glomerulonephritis With Massive Complement Deposition

Cited by 6 publications

References 31 publications

Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia

Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia

Updated diagnosis and graft involvement for visceral leishmaniasis in kidney transplant recipients: a case report and literature review

Humoral response in Leishmaniasis

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