Schistosomal specific nephropathy leading to end–stage renal failure

Abstract

In this study 17 patients, 11 with end-stage renal failure and six with nephrotic syndrome were selected. The selection criteria were presence of active intestinal schistosomiasis and absence of any surgical or other medical disease which could explain the renal disease. When examined by light microscopy, kidney biopsies showed membranoproliferative glomerulonephritis in nine, membranous in four, focal segmental glomerulosclerosis in two, sclerosing glomerulonephritis in one case, and no changes in another case. Direct immunofluorescence showed IgG deposits in 13 cases, IgM in 10 and different complement components (C3, C1q) in eight cases. Eluates from the kidney biopsies of the 17 schistosomal as well as six control cases were examined by ELISA against schistosoma mansoni adult worm antigen (AWA). This test showed the presence of antibodies against the AWA in 12 out of 17 of the schistosomal cases, and zero out of six of the controls. When examined by direct IFA using sheep anti-circulating anodic antigen/FITC and by indirect IFA using monoclonal antischistosomal CAA IgG3, kidney biopsies of the ELISA positive cases showed granular deposits of circulating anodic antigen (CAA). We conclude that schistosomal specific nephropathy does exist in the clinical settings and can lead to end-stage renal disease, with CAA probably being a major responsible antigen.

Immunopathology of Schistosoma mansoni infection

“…Antigen M was found in the blood, milk, and urine of infected patients and hamsters (58)(59)(60)249) and appears to be related to CCA (201); its occurrence also correlates with the intensity of infection. Demonstration of soluble egg antigens (SEA) in kidney extracts from infected baboons (167) but not mice (121) and of parasite deoxyribonucleic acid in the glomeruli of hamsters (160) (211,256). Glomerular lesions affecting the mesangial areas could also be produced in heavily infected experimental animals.…”

Cryoglobulinaemic vasculitis and glomerulonephritis associated with schistosomiasis: a case study

“…Schistosomiasis is classified according to the African Association of Nephrology (AFRAN) into 5 classes (1); Table 1 summarizes these classes, their pathology, clinical course and treatment. There is no role for immune suppression in schistosomal glomerulopathy, which is mostly an untreatable disease that may culminate in end-stage renal disease (1)(2)(3). We present here a case of schistosomal glomerulopathy with several peculiar, novel features.…”

Glomerulopathy associated with parasitic infections

“…Immunofluorescence and electron microscopy reveal the presence of immune complexes containing IgM, IgG, IgA, IgE, complement components, and schistosomal antigens in the mesangium and along the endothelial side of the capillary wall. Sometimes renal histological changes are found to precede clinical manifestations (5,9,69).…”