Section of Nephrology, Yale University School of Medicine, New Haven, CT.
Am J Kidney Dis. 2013 Oct;62(4):801-5. doi: 10.1053/j.ajkd.2013.02.376. Epub 2013 May 2.
Babesia is an obligate intracellular erythrocyte parasite that can infect humans. Severe symptomatic disease from massive hemolysis and multiorgan system failure, including acute kidney injury (AKI), occurs. Acute tubular injury from a combination of volume depletion and heme pigment toxicity from profound hemolysis is the most common cause of AKI. We present a case of severe babesiosis complicated by dialysis-requiring AKI with the unique finding of large macrophages containing engulfed erythrocyte fragments in urine sediment. This urinary finding raised the possibility of another diagnosis distinct from acute tubular injury. Subsequent kidney biopsy demonstrated infection-associated acute interstitial nephritis.
疟原虫是一种专性的红细胞内寄生寄生虫，可感染人类。严重的症状性疾病可由大量溶血和多器官系统衰竭引起，包括急性肾损伤（AKI）。急性肾小管损伤是由严重溶血引起的容量不足和血红素色素毒性的综合作用所致，是 AKI 的最常见原因。我们报告了一例严重巴贝斯虫病并发需要透析的 AKI 的病例，其尿液沉淀物中存在独特的大巨噬细胞，内含吞噬的红细胞碎片。这种尿液发现提示存在不同于急性肾小管损伤的另一种诊断可能。随后的肾脏活检显示感染相关性急性间质性肾炎。
