Renal lesions in leprosy amongst north Indian patients

Abstract

SummarySixty consecutive patients with leprosy were investigated for renal involvement. Clinically overt renal disease was present in 4 patients; 3 presented with a nephrotic state and one patient with progressive renal failure. Urinalysis showed daily protein loss ranging from 0-4 to 8-9 g in 8 patients and microscopic haematuriain 4 cases. Flevated levelsofblood urea and creatinine were seen only in one patient with diffuse proliferative glomerulonephritis. Of the 36 patients in whom distal tubular functions were evaluated, concentration and/or acldification defects were detected in 9 patients (25%). Renal histology revealed no abnormality in any of these patients. Serum C3 levels were decreased in 5 patients with lepromatous leprosy and 3 patients with borderline leprosy.Histological evidence of renal involvement was detected in 9 patients (15%). Amyloid deposits were seen in 3 (5%) patients of whom 2 had lepromatous leprosy and one had tuberculoid leprosy with chronic trophic ulcers. Mesangial proliferative lesions were seen in 5 (8*3%) and diffuse proliferative lesions (with crescents in more than 70% of glomeruli) in one patient. All of them had lepromatous leprosy. Three of the 5 patients with mesangial proliferative glomerulonephritis had erythema nodosum leprosum at the time of biopsy. Immunofluorescence studies revealed granular deposits of IgA, IgM and C3 in one patient with mesangial proliferation and IgA/IgM with or without C3 in 3 more patients in whom renal histology was normal. Glomerulonephritis associated with leprosy appears to be immune mediated but confirmation requires identification of lepra antigen in the glomerular immune complex deposits.

Systemic Manifestations of Leprosy: A Comprehensive Epidemiological Study from Eastern India

“…[18] Proteinuria has been described in several studies and its prevalence varies from 2.1 to 68%, and it is also more frequent in the multibacillary forms. [15,19,20,21,22] The prevalence of renal involvement in our study is comparable to previous studies. Experimental studies have suggested that reticuloendothelial system gets involved early in the course of the disease.…”

“…[14] Microscopic hematuria is found in 12-16% of cases, which is higher than what is found in the general population (0.5-2%). [15,16,17] This complication can disappear after a few months of specific treatment. [18] Proteinuria has been described in several studies and its prevalence varies from 2.1 to 68%, and it is also more frequent in the multibacillary forms.…”

Renal Abnormalities in Leprosy

“…Even though many biopsy and autopsy studies have since then been carried out, the exact pathogenesis of those renal lesions is still uncertain [4]. They become important if one considers that chronic renal failure, attributed in most cases to amyloidosis, is the main cause of death in leprosy [2,5].…”

Novel kidney injury biomarkers in tropical infections: a review of the literature

“…These uncommon cases were presented as case reports due to their rarity 31 . Glomerulonephritis seems to be the most common type of nephropathy in leprosy, accompanied by hematuria and increased proteinuria, especially in multibacillary forms 32,33 . The exact mechanism leading to the development of glomerulopathy is not completely understood.…”