Silva Geraldo Bezerra da, Pinto José Reginaldo, Barros Elvino José Guardão, Farias Geysa Maria Nogueira, Daher Elizabeth De Francesco
Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil.
Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Rio Grande do Sul, Brazil.
Rev Inst Med Trop Sao Paulo. 2017;59:e53. doi: 10.1590/S1678-9946201759053. Epub 2017 Aug 3.
Malaria is an infectious disease of great importance for Public Health, as it is the most prevalent endemic disease in the world, affecting millions of people living in tropical areas of the globe. Kidney involvement is relatively frequent in infections by P. falciparum and P. malariae, but has also been described in the infection by P. vivax. Kidney complications in malaria mainly occur due to hemodynamic dysfunction and immune response. Liver complications leading to hepatomegaly, jaundice and hepatic dysfunction can also contribute to the occurrence of acute kidney injury. Histologic studies in malaria also evidence glomerulonephritis, acute tubular necrosis and acute interstitial nephritis. It is also possible to find chronic kidney disease associated with malaria, mainly in those patients suffering from repeated episodes of infection. Plasmodium antigens have already been detected in the glomeruli, suggesting a direct effect of the parasite in the kidney, which can trigger an inflammatory process leading to different types of glomerulonephritis. Clinical manifestations of kidney involvement in malaria include proteinuria, microalbuminuria and urinary casts, reported in 20 to 50% of cases. Nephrotic syndrome has also been described in the infection by P. falciparum, but it is rare. This paper highlights the main aspects of kidney involvement in malaria and important findings of the most recent research addressing this issue.
疟疾是一种对公共卫生至关重要的传染病，因为它是世界上最普遍的地方病，影响着全球热带地区数以百万计的人口。恶性疟原虫和三日疟原虫感染时肾脏受累相对常见，但间日疟原虫感染也有相关报道。疟疾的肾脏并发症主要由于血液动力学功能障碍和免疫反应所致。导致肝肿大、黄疸和肝功能障碍的肝脏并发症也可能促使急性肾损伤的发生。疟疾的组织学研究还证实存在肾小球肾炎、急性肾小管坏死和急性间质性肾炎。也有可能发现与疟疾相关的慢性肾脏病，主要见于那些反复感染的患者。已在肾小球中检测到疟原虫抗原，提示寄生虫对肾脏有直接作用，可引发炎症过程，导致不同类型的肾小球肾炎。疟疾肾脏受累的临床表现包括蛋白尿、微量白蛋白尿和尿沉渣，在20%至50%的病例中可见。恶性疟原虫感染也有肾病综合征的报道，但较为罕见。本文重点介绍了疟疾肾脏受累的主要方面以及针对该问题的最新研究所取得的重要发现。
