Infectology and Tropical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Brazil.
Rev Soc Bras Med Trop. 2010 Nov-Dec;43(6):638-42. doi: 10.1590/s0037-86822010000600007.
The current prevalence of glomerulonephritis in patients with hepatosplenic schistosomiasis mansoni in Brazil was evaluated.
Sixty three patients (mean age 45.5 ± 11 years) attending the outpatient infectious disease clinic of a University Hospital in Belo Horizonte, Brazil, from 2007 to 2009, were consecutively examined and enrolled in the present investigation. Diagnosis of hepatosplenic schistosomiasis was based on epidemiological, clinical and parasitological data and imaging techniques. Eight patients, who presented >30 mg/day albuminuria, were submitted to percutaneous ultrasound guided renal biopsy. Kidney tissue fragments were examined under light, direct immunofluorescence and electron microscopy.
All patients showed mesangial enlargement. In five, mesangial hypercellularity was observed and four presented duplication of the glomerular basement membrane. Areas of glomerular sclerosis were diagnosed in four. Deposits of immunoglobulin M and C3 were present in six samples; deposits of IgG in four, IgA in three and C1q in two samples. In all patients, immunoglobulin A was reported in the lumen of renal tubules. Deposits of kappa and lambda were observed in six samples. Electron microscopy revealed dense deposits in the glomerular tissue of three patients. Arterial hypertension, small esophageal varices, slight increases in serum creatinine and decreases in serum albumin were associated with glomerular disease.
Renal disease associated with hepatosplenic schistosomiasis was verified in 12.7% of patients and type I membranoproliferative glomerulonephritis was observed in 50% of them. Schistosomal glomerulopathy still is an important problem in patients with hepatosplenic schistosomiasis in Brazil.
评估了巴西伴有肝脾血吸虫病的肾小球肾炎患者的当前患病率。
2007 年至 2009 年，巴西贝洛奥里藏特一所大学医院的传染病门诊连续检查并纳入了 63 例（平均年龄 45.5±11 岁）患者。肝脾血吸虫病的诊断基于流行病学、临床和寄生虫学数据以及影像学技术。8 例蛋白尿 >30mg/天的患者接受了经皮超声引导下的肾活检。在光镜、直接免疫荧光和电子显微镜下检查肾脏组织碎片。
所有患者均显示出系膜扩张。在 5 例患者中观察到系膜细胞增生，4 例患者出现肾小球基底膜的双重化。4 例诊断为肾小球硬化区。6 例样本中存在免疫球蛋白 M 和 C3 沉积；4 例存在 IgG 沉积，3 例存在 IgA 沉积，2 例存在 C1q 沉积。在所有患者中，免疫球蛋白 A 均报告存在于肾小管腔中。6 例样本中观察到κ和λ的沉积。电子显微镜显示 3 例患者的肾小球组织中存在致密沉积物。肾小球疾病与高血压、小食管静脉曲张、血清肌酐轻度升高和血清白蛋白降低有关。
在 12.7%的患者中证实了与肝脾血吸虫病相关的肾脏疾病，在其中 50%的患者中观察到 I 型膜增生性肾小球肾炎。在巴西，伴有肝脾血吸虫病的血吸虫性肾小球病仍然是一个重要问题。
