Little is known about renal alterations in kala-azar. The renal histopathology of 21 patients admitted to hospital in São Paulo, Brazil, during the period 1960 through 1981 who either died or had a renal biopsy (two cases) is presented. All the specimens showed oedema and diffuse interstitial inflammatory infiltrate of lymphocytes and plasma cells with more compact foci of cells in some areas. In general, glomeruli did not show any important alterations. These aspects were interpreted as acute interstitial nephritis aetiologically related to later phase kala-azar. This interstitial alteration does not usually seem to determine any clinical manifestations. However, it seems that moderate and severe cortical intersitial damage contribute to the onset of renal insufficiency when severe clinical complications occur. The precise mechanisms of this lesion need further investigation since the aetiological agents have not been seen causing the damage locally.

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BackgroundBleeding from gastric varices has high mortality rate, and obliteration using N-butyl-2-cyanoacrylate is the treatment of choice. Recurrent bacteremia is rarely reported following the procedure. We aimed to report a case of recurrent bacteremia after N-butyl-2-cyanoacrylate treatment and to review published cases.Case presentation and reviewIn May 2014, a 43-year-old Brazilian male presented with lower gastrointestinal bleeding. Endoscopy showed active bleeding from gastric varix. Injection of N-butyl-2-cyanoacrylate was performed and the patient was discharged. Over the next 4 months he presented with three episodes of bacteremia with severe sepsis and no identifiable focus of infection. Oral prophylaxis was initiated in September 2014 and he has remained free of bacteremia. Six other cases of recurrent bacteremia following sclerosis with N-butyl-2-cyanoacrylate were reported in the literature. All patients had portal hypertension and bleeding from gastric varices. Average age of patients was 55.7 years and the median time from endoscopic procedure to the first episode of bacteremia was 105 days (range 14–365). The mean number of episodes of bacteremia per patient was 2.5.ConclusionRecurrent bacteremia associated with endoscopic treatment with N-2-butyl-cyanoacrylate is rare, but should be suspected in patients in which investigation shows no other focus of infection. Secondary prophylaxis should be considered after the first episode.