Nephrotic syndrome associated with hepatointestinal schistosomiasis

Abensur, H.; Nussenzveig, I.; Saldanha, L.B.; Petalozzi, M.S.C.; Barros, M.T.; Marcondes, M.; Barros, R.T.

doi:10.1590/S0036-46651992000400002

Abstracts

Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (p<0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membra-noproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy.

Schistosoma mansoni; Schistosomal associated nephropathy; Nephrotic syndrome; Hepatointestinal schistosomiasis

A nefropatia esquistossomótica está classicamente vinculada à fornia hepatoesplênica da esquistossomose. Ao longo dos últimos anos 24 casos de pacientes esquistossomóticos hepato-intestinais e portadores de síndrome nefrótica foram estudados. Com o objetivo de verificar a possível participação etiológica da esquistossomose na gênese da nefropatia, analisamos este grupo comparativamente ao grupo de 37 doentes portadores de síndrome nefrótica idiopática. Ambos os grupos apresentaram distribuição distinta dos tipos histológicos de glomerulopatia. No grupo de esquistossomóticos houve predomínio estatisticamente significante de glomerulonefrite proliferativa mesangial (33.3%), enquanto no grupo controle houve predomínio da glomerulonefrite membranosa (32.4%). A positividade para IgM à imunofluorescência foi de 94.4% nos doentes esquistossomóticos versus 55.0% no grupo controle (p<0.01). No grupo de esquistossomóticos 8 pacientes evidenciaram glomerulonefrite proliferativa mesangial e 5, glomerulonefrite membranoproliferativa. Em ambos os tipos histológicos a imunofluorescência mostrou depósitos granulares de IgM e C3 nos glomérulos. Os dados do presente estudo sugerem que as glomerulonefrites proliferativa mesangial e membranoproliferativa, com depósitos glomerulares de IgM e C3 representam as lesões renais específicas da nefropatia esquistossomótica.

ORIGINAL ARTICLES

Nephrotic syndrome associated with hepatointestinal schistosomiasis

Síndrome nefrótica associada à esquistossomose hepatointestinal

H. Abensur^I; I. Nussenzveig^I; L.B. Saldanha^II; M.S.C. Petalozzi^I; M.T. Barros^III; M. Marcondes^I; R.T. Barros^I

^INephrology Division, Hospital das Clínicas, Faculty of Medicine, São Paulo University. São Paulo, Brazil

^IIPathology Division, Hospital das Clínicas, Faculty of Medicine, São Paulo University. São Paulo, Brazil

^IIIAllergy and Immunopathology Division, Faculty of Medicine, São Paulo University. São Paulo. Brasil

^{Address for correspondence} Address for correspondence: Prof. Dr. Israel Nussenzveig Nephrology Division, Hospital das Clínicas, São Paulo University Av. Dr. Enéas Carvalho de Aguiar, 255 Caixa Postal 8091, 05403 São Paulo, Brazil

SUMMARY

Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (p<0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membra-noproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C₃ granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C₃ deposits, represent the renal lesions of the schistosomiasis associated nephropathy.

Keywords: Schistosoma mansoni; Schistosomal associated nephropathy; Nephrotic syndrome; Hepatointestinal schistosomiasis.

RESUMO

A nefropatia esquistossomótica está classicamente vinculada à fornia hepatoesplênica da esquistossomose. Ao longo dos últimos anos 24 casos de pacientes esquistossomóticos hepato-intestinais e portadores de síndrome nefrótica foram estudados. Com o objetivo de verificar a possível participação etiológica da esquistossomose na gênese da nefropatia, analisamos este grupo comparativamente ao grupo de 37 doentes portadores de síndrome nefrótica idiopática. Ambos os grupos apresentaram distribuição distinta dos tipos histológicos de glomerulopatia. No grupo de esquistossomóticos houve predomínio estatisticamente significante de glomerulonefrite proliferativa mesangial (33.3%), enquanto no grupo controle houve predomínio da glomerulonefrite membranosa (32.4%). A positividade para IgM à imunofluorescência foi de 94.4% nos doentes esquistossomóticos versus 55.0% no grupo controle (p<0.01). No grupo de esquistossomóticos 8 pacientes evidenciaram glomerulonefrite proliferativa mesangial e 5, glomerulonefrite membranoproliferativa. Em ambos os tipos histológicos a imunofluorescência mostrou depósitos granulares de IgM e C₃ nos glomérulos. Os dados do presente estudo sugerem que as glomerulonefrites proliferativa mesangial e membranoproliferativa, com depósitos glomerulares de IgM e C₃ representam as lesões renais específicas da nefropatia esquistossomótica.

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Recebido para publicação em 03/09/1991

Aceito para publicação em 25/05/1992

References

1. ANDRADE, Z.A.; ANDRADE, S.G. & SADIGURSKY, M. - Renal changes in patients with Hepatosplenic Schistosomiasis. Amer. J. trop. Med. Hyg., 20: 77-82, 1971.
2. ANDRADE, Z.A. & ROCHA, H. - Schistosomal glomerulopathy. Kidney Int., 16: 23-29, 1979.
3. ANDRADE, Z.A. & VAN MARCK, E. - Schistosomal glomerular disease (a review). Mem. Inst. Oswaldo Cruz, 79: 499-506, 1984.
4. BRITO, T.; GUNJI, J.; CAMARGO, M.E.; PENNA, D.O. & SILVA, L.C. - Advanced kidney disease in patients with hepatosplenic Manson's schistosomiasis. Rev. Inst. Med. trop. S. Paulo, 12: 225-235, 1970.
5. GOLDMAN, M.; BARAN, D. & DRUET, F. - Polyclonal activation and experimental nephropathies. Kidney Int., 34: 141-150, 1988.
6. HOUBA, V. - Experimental renal disease due to Schistosomiasis. Kidney Int., 16: 30-43, 1979.
7. QUEIROZ, F.P.; BRITO, E.; MARTINELLI, R. & ROCHA, H. - Nephrotic syndrome in patients with Schistosoma mansoni infection. Amer. J. trop. Med. Hyg., 22: 622-627, 1973.
8. SILVA, L.C.; BRITO, T.; CAMARGO, M.E.; BONI, D.R.; LOPES, J.D. & GUNJI, J. - Kidney biopsy in the hepatosplenic form of infection with Schistosoma mansoni in man. Bull. Wld. Hlth. Org., 42: 907-910, 1970.
9. SOBH, M.; MOUSTAFA, F.; EL-ARBAGY, A.; SHEBAB EL-DIN, M.; SHARNAA, S. & AMER, G. - Nephropathy in asymptomatic patients with active Schistosoma mansoni infection. Int. Urol. Nephrol., 22: 37-43, 1990.
10. SOBH, M.A.; MOUSTAFA, F.E.; SALLY, S.M.; DEELDER, A.M. & GHONIEM, M.A. - Characterisation of kidney lesions in early Schistosomal-specific nephropathy. Nephrol. dial. Transplant. (Berlin), 3: 392-398, 1988.
11. VAN MARCK, E.; DEELDER, A.M. & GIGASE, P.L.J. - Effect of partial vein ligation on immune glomerular deposits in Schistosoma mansoni-infected mice. Brit. J. exp. Path., 58: 412-417, 1977.

Address for correspondence:

Prof. Dr. Israel Nussenzveig

Nephrology Division, Hospital das Clínicas, São Paulo University

Av. Dr. Enéas Carvalho de Aguiar, 255

Caixa Postal 8091, 05403 São Paulo, Brazil

Publication Dates

Publication in this collection
12 Sept 2006
Date of issue
Aug 1992

History

Accepted
25 May 1992
Received
03 Sept 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ANDRADE, Z.A.; ANDRADE, S.G. & SADIGURSKY, M. - Renal changes in patients with Hepatosplenic Schistosomiasis. Amer. J. trop. Med. Hyg., 20: 77-82, 1971.

[2] 2. ANDRADE, Z.A. & ROCHA, H. - Schistosomal glomerulopathy. Kidney Int., 16: 23-29, 1979.

[3] 3. ANDRADE, Z.A. & VAN MARCK, E. - Schistosomal glomerular disease (a review). Mem. Inst. Oswaldo Cruz, 79: 499-506, 1984.

[4] 4. BRITO, T.; GUNJI, J.; CAMARGO, M.E.; PENNA, D.O. & SILVA, L.C. - Advanced kidney disease in patients with hepatosplenic Manson's schistosomiasis. Rev. Inst. Med. trop. S. Paulo, 12: 225-235, 1970.

[5] 5. GOLDMAN, M.; BARAN, D. & DRUET, F. - Polyclonal activation and experimental nephropathies. Kidney Int., 34: 141-150, 1988.

[6] 6. HOUBA, V. - Experimental renal disease due to Schistosomiasis. Kidney Int., 16: 30-43, 1979.

[7] 7. QUEIROZ, F.P.; BRITO, E.; MARTINELLI, R. & ROCHA, H. - Nephrotic syndrome in patients with Schistosoma mansoni infection. Amer. J. trop. Med. Hyg., 22: 622-627, 1973.

[8] 8. SILVA, L.C.; BRITO, T.; CAMARGO, M.E.; BONI, D.R.; LOPES, J.D. & GUNJI, J. - Kidney biopsy in the hepatosplenic form of infection with Schistosoma mansoni in man. Bull. Wld. Hlth. Org., 42: 907-910, 1970.

[9] 9. SOBH, M.; MOUSTAFA, F.; EL-ARBAGY, A.; SHEBAB EL-DIN, M.; SHARNAA, S. & AMER, G. - Nephropathy in asymptomatic patients with active Schistosoma mansoni infection. Int. Urol. Nephrol., 22: 37-43, 1990.

[10] 10. SOBH, M.A.; MOUSTAFA, F.E.; SALLY, S.M.; DEELDER, A.M. & GHONIEM, M.A. - Characterisation of kidney lesions in early Schistosomal-specific nephropathy. Nephrol. dial. Transplant. (Berlin), 3: 392-398, 1988.

[11] 11. VAN MARCK, E.; DEELDER, A.M. & GIGASE, P.L.J. - Effect of partial vein ligation on immune glomerular deposits in Schistosoma mansoni-infected mice. Brit. J. exp. Path., 58: 412-417, 1977.