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Leprosy nephropathy: a review of clinical and histopathological features.

Silva Junior GB, Daher Ede F, Pires Neto Rda J, Pereira ED, Meneses GC, Araújo SM, Barros EJ - Rev. Inst. Med. Trop. Sao Paulo (2015 Jan-Feb)

Bottom Line: The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli.During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations.Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil.

ABSTRACT
Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

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Kidney biopsy from a patient with leprosy and chronic kidney diseaseshowing amyloid deposits (A), H&E, x200; glomeruli without mesangialproliferation, with amyloid deposit in mesangium, H&E, x400; amyloiddeposit, H&E x200; tubules without abnormalities, H&E x200. Reprintedfrom Silva Junior et al. Rev Soc Bras Med Trop. 2010;43:474-6.52
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f02: Kidney biopsy from a patient with leprosy and chronic kidney diseaseshowing amyloid deposits (A), H&E, x200; glomeruli without mesangialproliferation, with amyloid deposit in mesangium, H&E, x400; amyloiddeposit, H&E x200; tubules without abnormalities, H&E x200. Reprintedfrom Silva Junior et al. Rev Soc Bras Med Trop. 2010;43:474-6.52

Mentions: Several renal biopsy studies have been performed in leprosy. JOHNYet al.26 performed renal biopsies in 35 patients with leprosy and identified histologicalabnormalities in 45% of them, and the most frequent was proliferativeglomerulonephritis. GUPTA et al.20 performed renal biopsies in 21 patients with virchowian leprosy, and foundproliferative glomerulonephritis in 13 of them. GROVER et al.19, in a study with 54 renal biopsies found 12 cases (22.2%) of diffuseproliferative glomerulonephritis (11 virchowian and one tuberculoid). They also foundtwo cases of rapidly progressive glomerulonephritis, with acute kidney injury.Membranous nephropathy was found in 17 cases (31.5%). PHADNIS et al.42 performed 50 renal biopsies and identified membranous nephropathy in two casesand membranoproliferative glomerulonephritis in six cases, of whom 45 had thelepromatous form and had reactional state. Interstitial nephritis was observed in 10patients and amyloidosis in one case. Chronic kidney disease caused by secondaryamyloidosis has also been described in leprosy52 (Fig. 2).


Leprosy nephropathy: a review of clinical and histopathological features.

Silva Junior GB, Daher Ede F, Pires Neto Rda J, Pereira ED, Meneses GC, Araújo SM, Barros EJ - Rev. Inst. Med. Trop. Sao Paulo (2015 Jan-Feb)

Kidney biopsy from a patient with leprosy and chronic kidney diseaseshowing amyloid deposits (A), H&E, x200; glomeruli without mesangialproliferation, with amyloid deposit in mesangium, H&E, x400; amyloiddeposit, H&E x200; tubules without abnormalities, H&E x200. Reprintedfrom Silva Junior et al. Rev Soc Bras Med Trop. 2010;43:474-6.52
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325518&req=5

f02: Kidney biopsy from a patient with leprosy and chronic kidney diseaseshowing amyloid deposits (A), H&E, x200; glomeruli without mesangialproliferation, with amyloid deposit in mesangium, H&E, x400; amyloiddeposit, H&E x200; tubules without abnormalities, H&E x200. Reprintedfrom Silva Junior et al. Rev Soc Bras Med Trop. 2010;43:474-6.52
Mentions: Several renal biopsy studies have been performed in leprosy. JOHNYet al.26 performed renal biopsies in 35 patients with leprosy and identified histologicalabnormalities in 45% of them, and the most frequent was proliferativeglomerulonephritis. GUPTA et al.20 performed renal biopsies in 21 patients with virchowian leprosy, and foundproliferative glomerulonephritis in 13 of them. GROVER et al.19, in a study with 54 renal biopsies found 12 cases (22.2%) of diffuseproliferative glomerulonephritis (11 virchowian and one tuberculoid). They also foundtwo cases of rapidly progressive glomerulonephritis, with acute kidney injury.Membranous nephropathy was found in 17 cases (31.5%). PHADNIS et al.42 performed 50 renal biopsies and identified membranous nephropathy in two casesand membranoproliferative glomerulonephritis in six cases, of whom 45 had thelepromatous form and had reactional state. Interstitial nephritis was observed in 10patients and amyloidosis in one case. Chronic kidney disease caused by secondaryamyloidosis has also been described in leprosy52 (Fig. 2).

Bottom Line: The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli.During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations.Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil.

ABSTRACT
Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

Show MeSH
Related in: MedlinePlus