El Jeri H Kaaroud, Harzallah A, Barbouch S, Bacha M M, Kheder R, Turki S, Trabelsi S, Abderrahim E, Hamida F Ben, Abdallah T Ben
Department of Medicine A, Charles Nicolle Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.
Department of Nephrology, La Rabta Hospital; Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.
Saudi J Kidney Dis Transpl. 2017 Jan-Feb;28(1):95-101. doi: 10.4103/1319-2442.198159.
The aim of this study is to evaluate the features of visceral leishmaniasis (VL) in adults with nephropathy, who were not infected with the human immunodeficiency virus. This is a retrospective study of 14 adults hospitalized between 2000 and 2014, with VL and renal involvement. Clinical, biological, and therapeutic data were collected from the patients' medical files. Eleven women and three men, most of whom were from the North of the country, with a mean age of 40.5 years were studied. Lupus was present in five cases, the Sicca syndrome in three cases, diabetes in one case, renal failure on dialysis in two cases, and there were three renal transplant recipients. Major clinical symptoms were fever and weakness in all cases. Enlargement of the spleen was present in eight cases and hepatomegaly in six cases. Biologic inflammatory syndrome and anemia were present in all cases, and pancytopenia was present in seven cases. Renal insufficiency was noted in all cases. Diagnosis of VL was confirmed by bone marrow examination or serology. Treatment consisted of antimoniate in 10 cases and amphotericin B in four cases. Seven deaths were recorded. Clinical symptoms of VL are atypical in patients with nephropathy and therefore, the diagnosis should be suspected in such patients because VL is still endemic in our country.
本研究的目的是评估未感染人类免疫缺陷病毒的成年肾病患者内脏利什曼病（VL）的特征。这是一项对2000年至2014年间住院的14例患有VL且有肾脏受累的成年人进行的回顾性研究。从患者的病历中收集临床、生物学和治疗数据。研究对象包括11名女性和3名男性，大多数来自该国北部，平均年龄为40.5岁。5例患有狼疮，3例患有干燥综合征，1例患有糖尿病，2例接受透析治疗的肾衰竭患者，还有3例肾移植受者。所有病例的主要临床症状为发热和虚弱。8例出现脾肿大，6例出现肝肿大。所有病例均存在生物性炎症综合征和贫血，7例存在全血细胞减少。所有病例均有肾功能不全。通过骨髓检查或血清学确诊为VL。10例采用锑剂治疗，4例采用两性霉素B治疗。记录到7例死亡。肾病患者中VL的临床症状不典型，因此，鉴于VL在我国仍为地方病，对此类患者应怀疑有VL感染。
