Continuous hypergammaglobulinemia and proteinuria after the recovery of the visceral Leishmaniasis: a case report

Abstract Background Kidney involvement of visceral Leishmaniasis is previously reported, but knowledge is limited. Hypergammaglobulinemia is common in visceral leishmaniasis patients. Whether hypergammaglobulinemia after leishmaniasis depletion can cause kidney injury is not well reported yet. Case presentation We reported a patient who recovered from visceral Leishmaniasis but showed persistent hypergammaglobulinemia and elevated urinary protein. Kidney biopsy showed glomerular hypertrophy with mild segmental mesangial proliferation without tubulointerstitial involvement in light microscopy. No immune complex deposit was found in the mesangial area by neither immunofluorescent staining nor electronic microscope. Increased lysosomes were observed in proximal tubules by electronic microscope. Valsartan was administered to decrease urinary protein, and no immune-suppressive therapy was added. The urinary protein and serum IgG level gradually dropped, and serum creatinine level remained stable during three- month follow up. Conclusions Hypergammaglobulinemia is unlikely to cause renal structural or functional damage in the short term. Angiotensin blockade significantly reduced urine protein, with a minor effect on IgG elimination.

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Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0252419 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252419

Author(s):

Workagegnehu Hailu ◽

Rezika Mohamed ◽

Helina Fikre ◽

Saba Atnafu ◽

Azeb Tadesse ◽

...

Keyword(s):

Acute Kidney Injury ◽

Visceral Leishmaniasis ◽

Incomplete Data ◽

Kidney Injury ◽

Northwest Ethiopia ◽

Treatment Center ◽

Limited Data ◽

Drug Induced ◽

Kidney Involvement ◽

Male Patients

Background Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia. Methods A hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05. Results Among 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20–27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99–18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37–8.65, p = 0.009) to be independently associated with AKI. Conclusion AKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.

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Pathomechanisms in the Kidneys in Selected Protozoan Parasitic Infections

International Journal of Molecular Sciences ◽

10.3390/ijms22084209 ◽

2021 ◽

Vol 22 (8) ◽

pp. 4209

Author(s):

Karolina Kot ◽

Natalia Łanocha-Arendarczyk ◽

Michał Ptak ◽

Aleksandra Łanocha ◽

Elżbieta Kalisińska ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Molecular Mechanisms ◽

Kidney Injury ◽

Therapeutic Interventions ◽

Parasitic Infections ◽

Injury Mechanisms ◽

Kidney Involvement ◽

Leishmania Spp ◽

Apoptosis Process ◽

Insight Into

Leishmaniasis, malaria, toxoplasmosis, and acanthamoebiasis are protozoan parasitic infections. They remain important contributors to the development of kidney disease, which is associated with increased patients’ morbidity and mortality. Kidney injury mechanisms are not fully understood in protozoan parasitic diseases, bringing major difficulties to specific therapeutic interventions. The aim of this review is to present the biochemical and molecular mechanisms in kidneys infected with Leishmania spp., Plasmodium spp., Toxoplasma gondii, and Acanthamoeba spp. We present available mechanisms of an immune response, oxidative stress, apoptosis process, hypoxia, biomarkers of renal injury in the serum or urine, and the histopathological changes of kidneys infected with the selected parasites. Pathomechanisms of Leishmania spp. and Plasmodium spp. infections have been deeply investigated, while Toxoplasma gondii and Acanthamoeba spp. infections in the kidneys are not well known yet. Deeper knowledge of kidney involvement in leishmaniasis and malaria by presenting their mechanisms provides insight into how to create novel and effective treatments. Additionally, the presented work shows gaps in the pathophysiology of renal toxoplasmosis and acanthamoebiasis, which need further research.

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First Reported Case in Romania of a Successfully Treated Severe COVID-19 in a Kidney Transplant Recipient: A Focus on Acute Kidney Injury

Case Reports in Nephrology and Dialysis ◽

10.1159/000512606 ◽

2020 ◽

Vol 10 (3) ◽

pp. 174-179

Author(s):

Flaviu Tosa ◽

Roxana Manaila ◽

Alina Elec ◽

Tudor Moisoiu ◽

Liviu Ghervan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Clinical Status ◽

Organ Transplant ◽

Treatment Strategies ◽

Kidney Injury ◽

Kidney Graft ◽

Kidney Involvement

As coronavirus disease 2019 (COVID-19) caused by the novel virus SARS-CoV-2 is expanding worldwide, kidney involvement seems to be part of the spectrum of its effects. Moreover, the prognosis of the disease seems to be worse in immunocompromised patients when compared to the general population, with 4–5 times higher mortality rates. However, the overall impact on long-term function of the kidney graft is unknown. We report on a case of a 46-year-old kidney transplant recipient who was successfully treated for severe COVID-19 pneumonia. The clinical course was complicated by transient acute kidney injury, most likely due to tubulo-interstitial involvement, with return to the baseline of the creatinine level by the time of discharge. We discuss the characteristics and differential diagnosis of acute kidney injury, as well as management of immunosuppression in connection with overall clinical status and evolution of kidney function. The case is illustrative for dilemmas that transplant professionals may face in the absence of evidence-based, efficient COVID-19 therapy. The risk-benefit balance of the yet to be approved treatment strategies may be weighed differently in organ transplant recipients owing to their immunocompromised status and potential drug interactions with immunosuppressive therapy.

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Acute kidney injury and its outcomes in melioidosis

Journal of Nephrology ◽

10.1007/s40620-021-00970-x ◽

2021 ◽

Author(s):

Ravindra Attur Prabhu ◽

Tushar Shaw ◽

Indu Ramachandra Rao ◽

Vandana Kalwaje Eshwara ◽

Shankar Prasad Nagaraju ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Univariate Analysis ◽

Kidney Injury ◽

Function Recovery ◽

Kidney Involvement ◽

Duration Of Hospitalization ◽

Observational Cohort ◽

Stage 1 ◽

Urinary Abnormalities

Abstract Background Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described. Aim This study aimed to assess the risk of acute kidney injury (AKI) and its outcomes in melioidosis. Methods A retrospective observational cohort study was performed. Case records of consecutive patients with culture-confirmed melioidosis, observed from January 1st, 2012 through December 31st, 2019 were analysed for demographics, presence of comorbidities, including chronic kidney disease (CKD), diabetes mellitus (DM), and presence of bacteraemia, sepsis, shock, AKI, and urinary abnormalities. The outcomes we studied were: mortality, need for hospitalisation in an intensive care unit (ICU), duration of hospitalization. We then compared the outcomes between patients with and without AKI. Results Of 164 patients, AKI was observed in 59 (35.98%), and haemodialysis was required in eight (13.56%). In the univariate analysis, AKI was associated with CKD (OR 5.83; CI 1.140–29.90, P = 0.03), bacteraemia (OR 8.82; CI 3.67–21.22, P < 0.001) and shock (OR 3.75; CI 1.63–8.65, P = 0.04). In the multivariate analysis, CKD (adjusted OR 10.68; 95% CI 1.66–68.77; P = 0.013) and bacteraemia (adjusted OR 8.22; 95% CI 3.15–21.47, P < 0.001) predicted AKI. AKI was associated with a greater need for ICU care (37.3% vs. 13.3%, P = 0.001), and mortality (32.2% vs. 5.7%, P < 0.001). Mortality increased with increasing AKI stage, i.e. stage 1 (OR 3.52, CI 0.9–13.7, P = 0.07), stage 2 (OR 6.79, CI 1.92–24, P = 0.002) and stage 3 (OR 17.8, CI 5.05–62.8, P < 0.001), however kidney function recovered in survivors. Hyponatremia was observed in 138 patients (84.15%) and isolated urinary abnormalities were seen in 31(18.9%). Conclusions AKI is frequent in melioidosis and occurred in 35.9% of our cases. Hyponatremia is likewise common. AKI was predicted by bacteraemia and CKD, and was associated with higher mortality and need for ICU care; however kidney function recovery was observed in survivors. Graphic abstract

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Renal resistivity index as an aid in the diagnosis of acute kidney injury in bitches with pyometra

Acta Veterinaria Brasilica ◽

10.21708/avb.2021.15.3.9647 ◽

2021 ◽

Vol 15 (3) ◽

pp. 225-228

Author(s):

Aline de Sousa Alves ◽

Fernanda Vieira Henrique ◽

Sabrina Barros Araújo ◽

Dayanny de Sousa Alencar ◽

Higina Moreira Melo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Small Animal ◽

Kidney Injury ◽

Urinary Protein ◽

Creatinine Ratio ◽

Resistivity Index ◽

Gamma Glutamyltransferase ◽

Early Markers ◽

The Right

This study aimed to evaluate the renal function of six bitches of various breeds and ages, with open pyometra, attended in the Small Animal Medical Clinic sector of the Veterinary Hospital from Federal University of Campina Grande, through the measurement of laboratory tests: urea and creatinine serum, dosage of the urinary Protein-Creatinine Ratio (PCR), urinary gamma-glutamyltransferase (GGT) and determination of the renal resistivity index (RI). The levels of urea and creatinine were elevated in 16.6% (1/6) of the female dogs; the urinary protein-creatinine ratio was increased in 66.6% (4/6), while the urinary gamma-glutamyltransferase value was elevated in 50% (3/6). The renal resistivity index was increased in the right and left kidneys by 66.6% (4/6) of bitches, with no statistical difference between them. It was concluded that the renal resistivity index was a practical and effective method to assist in the diagnosis of acute kidney injury, along with other early markers, such as PCR and urinary GGT.

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miR-125b Disrupts Mitochondrial Dynamics via Targeting Mitofusin 1 in Cisplatin-Induced Acute Kidney Injury

Kidney Diseases ◽

10.1159/000520140 ◽

2021 ◽

pp. 1-11

Author(s):

Yue Zhao ◽

Yue Lang ◽

Mingchao Zhang ◽

Shaoshan Liang ◽

Xiaodong Zhu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Molecular Mechanisms ◽

Mitochondrial Dynamics ◽

Kidney Injury ◽

Immunofluorescent Staining ◽

Luciferase Reporter ◽

Mitochondrial Fragmentation ◽

Tubular Cells ◽

Renal Tubular Cells

Background: Mitochondria are dynamic organelles whose structure are maintained by continuous fusion and fission. During acute kidney injury (AKI) progression, mitochondrial fission in renal tubular cells was elevated, characterized by mitochondrial fragmentation. It is tightly associated with mitochondrial dysfunction, which has been proven as a critical mechanism responsible for AKI. However, the initiating factor for the disruption of mitochondrial dynamics in AKI was not well understood. Objectives: To explore the molecular mechanisms of mitochondrial disorders and kidney damage. Methods: We established cisplatin-induced AKI model in C57BL/6 mice and proximal tubular cells, and detected the expression of miR-125b by qPCR. Then we delivered miR-125b antagomir after cisplatin treatment in mice via hydrodynamic-based gene transfer technique. Subsequently, we performed luciferase reporter and immunoblotting assays to prove miR-125b could directly modulate mitofusin1 (MFN1) expression. We also tested the role of miR-125b in mitochondrial and renal injury through immunofluorescent staining, qPCR, and immunoblotting assays. Results: miR-125b levels were induced in cisplatin-challenged mice and cultured tubular cells. Anti-miR-125b could effectively alleviate cisplatin-induced mitochondrial fragmentation and kidney injury both in vitro and in vivo. Furthermore, miR-125b could directly regulate MFN1, which is a key regulator of mitochondrial fusion. Our study indicated that miR-125b is upregulated during cisplatin-induced AKI. Inhibition of miR-125b may suppress mitochondrial and renal damage through upregulating MFN1. This study suggests that miR-125b could be a potential therapeutic target in AKI.

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An Unusual Case of Acquired Angioedema and Monoclonal Gammopathy of Renal Significance in a Middle-Aged Caucasian Female

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620912096 ◽

2020 ◽

Vol 8 ◽

pp. 232470962091209 ◽

Cited By ~ 1

Author(s):

Sasmit Roy ◽

Venu Madhav Konala ◽

Thurein Kyaw ◽

Sandipan Chakraborty ◽

Srikanth Naramala ◽

...

Keyword(s):

Acute Kidney Injury ◽

B Cell ◽

Monoclonal Gammopathy ◽

Cell Clone ◽

Kidney Injury ◽

Caucasian Woman ◽

Acquired Angioedema ◽

Systemic Involvement ◽

Kidney Involvement ◽

Esterase Inhibitor

Acquired angioedema due to deficiency of C1 esterase inhibitor is also called acquired angioedema and is abbreviated as C1INH-AAE. It is a rare syndrome of recurrent episodes of angioedema, without urticaria, and in some patients, it is associated with B-cell lymphoproliferative disorders. Kidney involvement is rare in this condition. The monoclonal immunoglobulin secreted by a nonmalignant or premalignant B-cell or plasma cell clone, causing renal damage that represents a group of disorders which are termed as monoclonal gammopathy of renal significance (MGRS). In this article, we report a rare case of acquired C1 esterase deficiency angioedema and acute kidney injury with renal biopsy-proven MGRS. We present a 64-year-old Caucasian woman who presented with 2 weeks of recurring urticaria and new onset of acute kidney injury. She was diagnosed with monoclonal gammopathy–associated proliferative glomerulopathy through kidney biopsy, and serological workup came back positive for C1 esterase deficiency, implying acquired angioedema. Acquired angioedema is a rare disease with systemic involvement. Recurrent allergic manifestations and acute kidney injury should prompt MGRS as a differential.

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Leptospirosis

10.1093/med/9780199592548.003.0191 ◽

2015 ◽

Author(s):

Emmanuel A. Burdmann

Keyword(s):

Acute Kidney Injury ◽

Antibiotic Therapy ◽

Liver Failure ◽

Tubulointerstitial Nephritis ◽

Kidney Injury ◽

Pulmonary Haemorrhage ◽

Zoonotic Diseases ◽

Kidney Involvement ◽

Life Threatening ◽

Red Eyes

Leptospirosis is one of the most prevalent zoonotic diseases worldwide. Pathogenic spirochaetes are shed in the urine of infected mammals to the environment. Humans are infected through contact with contaminated material. Leptospirosis is more prevalent in tropical and subtropical areas, but exists in all continents except Antarctica. The disease is difficult to diagnose and hence frequently neglected. Its clinical picture ranges from a mild flu-like disease to a life-threatening form with pulmonary haemorrhage, liver failure and acute kidney injury (AKI), called Weil disease, which may affect 10% of those with clinical disease. Typically, fever, myalgia and headache progress to nausea and vomiting, jaundice, red eyes, and other manifestation affecting skin, brain, and other organs.Kidney involvement, characterized by acute tubulointerstitial nephritis, is nearly universal. It may be clinically manifested as a tubulopathy with urinary electrolytes wasting, hypokalaemia and hypomagnesaemia and/or as AKI, which is more frequently non-oliguric. Antibiotic therapy may reduce hospitalization time and AKI frequency. Otherwise management is supportive, including timely and adequate dialysis support.

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Leishmaniasis and trypanosomiasis

10.1093/med/9780199592548.003.0184_update_001 ◽

2018 ◽

Author(s):

Vinay Sakhuja ◽

Harbir Singh Kohli

Keyword(s):

Kidney Injury ◽

Reticuloendothelial System ◽

Experimental Models ◽

Urinary Concentration ◽

Tsetse Flies ◽

Kala Azar ◽

Insidious Onset ◽

Kidney Involvement ◽

Necrotizing Glomerulonephritis ◽

Diffuse Proliferative Glomerulonephritis

Visceral leishmaniasis, also known as kala-azar, has an insidious onset with constitutional features. Subsequently the intense parasitism of the reticuloendothelial system causes hepatosplenomegaly, anaemia, leucopenia, and thrombocytopaenia as well as hypergammaglobulinaemia. Kidney involvement manifests with proteinuria up to 1 g/24 hours, micro/macrohaematuria, and leucocyturia. Kidney involvement is generally mild and reversible with the treatment of infection. Biopsy appearances of diffuse proliferative glomerulonephritis, mesangial proliferation, and occasionally focal necrotizing glomerulonephritis with crescents have been described. Defects of urinary concentration and acidification have also been observed. Acute kidney injury (AKI) may be seen in one-third of patients and is associated with increased mortality.Trypanosomiasis has two forms. It causes sleeping sickness in Africa (T. brucei, transmitted by tsetse flies) or Chagas disease in South America (T. cruzei, transmitted by reduvid bugs). There is no direct association of these conditions with nephropathy, although there is in experimental models. AKI may occur, typically as a manifestation of multi-organ failure in African trypanosomiasis. APOL1 genotypes that confer susceptibility to FSGS are protective against T. brucei infection.

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