Department of Internal Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
PLoS One. 2021 Jun 8;16(6):e0252419. doi: 10.1371/journal.pone.0252419. eCollection 2021.
Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia.
A hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05.
Among 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20-27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99-18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37-8.65, p = 0.009) to be independently associated with AKI.
AKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.
内脏利什曼病（VL）是一种在包括埃塞俄比亚在内的多个国家流行的被忽视的热带病。在非洲以外，肾脏受累在 VL 中很常见，并与死亡率增加有关。然而，在东非，特别是在 HIV 合并感染率较高的地区，VL 患者急性肾损伤（AKI）的数据有限。本研究旨在确定埃塞俄比亚西北部 VL 患者 AKI 的患病率、特征和相关因素。
进行了一项基于医院的回顾性患者病历分析，纳入了 2019 年 1 月至 2019 年 12 月在埃塞俄比亚贡德尔利什曼病研究和治疗中心（LRTC）接受 VL 治疗的患者。在研究地点参加正在进行的临床试验的患者和数据明显不完整的患者被排除在外。使用 SPSS 版本 20 进行数据分析。如果 P 值<0.05，则认为具有统计学意义。
在研究期间在 LRTC 接受 VL 治疗的 352 名患者中，有 298 名被纳入研究。除两名患者外，所有患者均为男性；中位年龄为 23 岁（IQR：20-27）。VL 患者 AKI 的总体患病率为 17.4%（置信区间（CI）：13.6%-22.2%）。入院时，前肾性氮质血症（57%）和药物性 AKI（50%）是 AKI 的主要病因，而入院后则分别为蛋白尿和血尿。85%的 AKI 患者出现蛋白尿，42%的 AKI 患者出现血尿。多变量逻辑回归显示，HIV 合并感染（调整后的优势比（AOR）：6.01 95%CI：1.99-18.27，p=0.001）和其他合并感染（AOR：3.44 95%CI：1.37-8.65，p=0.009）与 AKI 独立相关。
AKI 是埃塞俄比亚 VL 患者的常见并发症。其他肾脏表现包括蛋白尿、血尿和脓尿。HIV 合并感染和其他合并感染与 AKI 显著相关。需要进一步研究来量化蛋白尿，并评估 AKI 对 VL 患者治疗过程、发病率和死亡率的影响。
