Lima Verde Francisco A A, Lima Verde Frederico A, Lima Verde Islene A, Silva Junior Geraldo B, Daher Elizabeth F, Lima Verde Emir M
Instituto de Nefrologia do Ceará (INECE), Fortaleza, CE, Brazil.
J Nephrol. 2007 Jul-Aug;20(4):430-6.
There are few studies of renal function evaluation in visceral leishmaniasis (kala-azar). The aim of this study was to evaluate glomerular filtration rate (GFR) and tubular function as urinary acidification capacity and maximal urinary concentration, in patients with the chronic form of kala-azar.
This is a cross-sectional study of 50 consecutive patients with kala-azar. GFR was calculated by 24-hour creatinine clearance. Urinary pH, titratable acidity and urinary ammonia excretion were measured after acid-loading with NH4Cl. Urine to plasma osmolality ratio (U/Posm) was evaluated after water withdrawal and vasopressin administration. All parameters were also measured in 20 healthy volunteers (control group).
GFR was normal in 44% of the patients, elevated in one third, and decreased in the remaining 28%. Decreased GFR was attributed to fluid loss, hypotension and immunological glomerular disease. Urinary concentrating capacity was abnormal in 68% of the patients with kala-azar after pitressin administration. A urinary pH higher than 5.5 was seen in 64% of cases after ammonium chloride acidification test. There was decreased formation of titratable acidity in 64% and low formation of ammonia urinary excretion in 30% of cases. Complete distal renal tubular acidosis was observed in 30% of patients and an incomplete form was found in 34%.
Abnormalities in glomerular filtration, urinary concentration and acidification are consistently associated to the chronic form of kala-azar and can be a consequence of the immunological system dysregulation that occurs in this disease.
关于内脏利什曼病（黑热病）肾功能评估的研究较少。本研究旨在评估慢性黑热病患者的肾小球滤过率（GFR）以及作为尿酸化能力和最大尿浓缩能力的肾小管功能。
这是一项对50例连续的黑热病患者进行的横断面研究。通过24小时肌酐清除率计算GFR。在用氯化铵进行酸负荷后，测量尿液pH值、可滴定酸度和尿氨排泄量。在禁水和给予血管加压素后评估尿渗透压与血浆渗透压之比（U/Posm）。所有参数也在20名健康志愿者（对照组）中进行了测量。
44%的患者GFR正常，三分之一的患者GFR升高，其余28%的患者GFR降低。GFR降低归因于液体丢失、低血压和免疫性肾小球疾病。给予血管加压素后，68%的黑热病患者尿浓缩能力异常。在氯化铵酸化试验后，64%的病例尿液pH值高于5.5。64%的病例可滴定酸度形成减少，30%的病例尿氨排泄形成减少。30%的患者观察到完全性远端肾小管酸中毒，34%的患者发现不完全形式。
肾小球滤过、尿浓缩和酸化异常与慢性黑热病持续相关，可能是该疾病中发生的免疫系统失调的结果。
