Nephrotic syndrome complicating chronic visceral leishmaniasis: re-emergence in patients with AIDS

Alex, Sunu; Criado, C. Fernandez; Ml, Fernández-Guerrero; M, de Górgolas; Petkov,; A, Garcia Perez; Egido, Jesús; Barat, A.; Manzarbeitia, Félix; Caramelo, Carlos; Ortiz, Alberto

doi:10.5414/cnp70065

Cited by 13 publications

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“…VL in HIV patients is a relapsing disorder characterized by a low cure rate, increased toxicity of anti-leishmania drugs, and the parasite’s location in unusual places such as the kidney [ 5 , 9 ]; these characteristics were apparent in this patient.…”

Section: Discussionmentioning

confidence: 99%

Membranoproliferative Glomerulonephritis due to Visceral Leishmaniasis in an HIV Patient

et al. 2015

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Patient: Male, 47Final Diagnosis: Membranoproliferative glomerulonephritisSymptoms: Nephrotic syndromeMedication: —Clinical Procedure: Renal biopsySpecialty: NephrologyObjective:Rare diseaseBackground:Visceral leishmaniasis is an important opportunistic disease in HIV-positive patients. The information available on the effects of such co-infection in the kidney is limited. We describe a patient with HIV/leishmania coinfection who developed nephrotic syndrome and membranoproliferative glomerulonephritis. As far as we know, only 2 cases of this nephropathy in HIV/leishmania coinfection have been reported.Case Report:A 47-year-old man developed nephrotic syndrome. He had been diagnosed with HIV infection and visceral leishmaniasis and was treated with antiretroviral therapy, antimonial compounds, liposomal amphotericin B and miltefosine, but the leishmania followed a relapsing course.Renal biopsy disclosed membranoproliferative glomerulonephritis and leishmania amastigotes were seen within glomerular capillary lumens. He was given miltefosine and liposomal amphotericin B but the leishmaniasis persisted. Stage 3B chronic renal disease and nephrotic range proteinuria tend to become stable by 15-month follow-up.Conclusions:Our case illustrated some aspects of leishmaniasis in HIV patients: its relapsing course, the difficulties in therapy, and the renal involvement.

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Section: Discussionmentioning

confidence: 99%

Membranoproliferative Glomerulonephritis due to Visceral Leishmaniasis in an HIV Patient

et al. 2015

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Pharmacotherapy for Leishmaniasis in the United States: Focus on Miltefosine

2015

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Leishmaniasis is a protozoan infection native to various countries, including those in South America and Southeast Asia. Although the incidence of leishmaniasis is low in the United States, it is an important cause of infection in individuals traveling to endemic areas. Various treatment modalities are available, depending on their availability in the geographic region. In the United States, the treatment of choice is considered to be liposomal amphotericin, although other therapies have been explored. In 2014, miltefosine became the first orally available medication approved for the treatment of leishmaniasis in the United States. Based on available data, miltefosine is a first-line option for the treatment of leishmaniasis. Miltefosine is equally efficacious to and may be as tolerable as liposomal amphotericin B. The most common adverse effects of miltefosine are vomiting, diarrhea, and transient liver enzyme level elevation. Miltefosine has not been readily available in the United States due to marketing delays and is expected to become available later this year. In the meantime, the drug may be obtained through the Centers for Disease Control and Prevention expanded-access investigational new drug protocol.

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