Gonçalves Fabiana Oliveira, Fontes Tânia Maria de Souza, Canuto Ana Paula Pereira Santana Lemes
Escola Superior de Ciências da Saúde, Brazil.
Secretaria e Estado de Saúde do Distrito Federal, Brazil.
J Bras Nefrol. 2017 Mar;39(1):86-90. doi: 10.5935/0101-2800.20170015.
Renal involvement is a severe form of schistosomiasis and occurs in 10% to 15% of patients with the hepatosplenic form of the disease. Nephrotic syndrome is the most common clinical presentation. It is a complication caused by immune complexes (IC), it is rare to appear in the Brazilian context with a immunoglobulin A (IgA) deposits. When installed the renal injury by Schistosoma mansoni, classically presents as membranoproliferative glomerulonephritis (mesangiocapillary) with lobular accentuation.
To report a case of schistosomiasis nephropathy that appeared 7 years after treatment of hepatosplenic schistosomiasis with histologic pattern of mesangial proliferative glomerulonephritis with IgA deposits in mesangium. Clinically developed with progressive decrease of proteinuria with angiotensin receptor blocker (ARB).
It was reported a case of a 36 years old patient, brown, with classical sintoms of nephrotic syndrome (proteinuria > 3.5 g/24h, hypoalbuminemia and hypercholesterolemia), however with hepatosplenic schistosomiasis history 7 years ago and portal hypertension. Patient underwent renal biopsy which showed IgA deposits in mesangial, being more intense than immunoglobulin G (IgG), accompanied by C1q and C3, with 4/13 glomeruli sclerotic, standard light mesangial glomerulonephritis renal injury with IgA deposits. Patient began taking ARB with progressive improvement in proteinuria.
Patients with glomerulonephritis by schistosoma don't show improvement of disease progression with antiparasitic treatment. However the anti-proteinuric treatment can slow the progression of end stage kidney disease.
肾脏受累是血吸虫病的一种严重形式，发生在10%至15%的肝脾型血吸虫病患者中。肾病综合征是最常见的临床表现。它是由免疫复合物（IC）引起的并发症，在巴西背景下伴有免疫球蛋白A（IgA）沉积的情况很少见。当曼氏血吸虫导致肾脏损伤时，经典表现为伴有小叶加重的膜增生性肾小球肾炎（系膜毛细血管性）。
报告一例肝脾型血吸虫病治疗7年后出现的血吸虫病肾病病例，其组织学表现为系膜增生性肾小球肾炎，系膜中有IgA沉积。临床上使用血管紧张素受体阻滞剂（ARB）后蛋白尿逐渐减少。
报告一例36岁男性患者，有肾病综合征的典型症状（蛋白尿>3.5g/24小时、低白蛋白血症和高胆固醇血症），但7年前有肝脾型血吸虫病病史及门静脉高压。患者接受了肾活检，结果显示系膜中有IgA沉积，比免疫球蛋白G（IgG）更明显，伴有C1q和C3，13个肾小球中有4个硬化，符合系膜IgA沉积的标准轻度系膜肾小球肾炎肾损伤。患者开始服用ARB后蛋白尿逐渐改善。
血吸虫性肾小球肾炎患者接受抗寄生虫治疗后疾病进展无改善。然而，抗蛋白尿治疗可以减缓终末期肾病的进展。
