Leprosy Nephropathy: A Review of Clinical and Histopathological Features

Abstract

Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

Infection-Induced Kidney Diseases

“…In a report of 122 cases from India, reduced creatinine clearance, and proteinuria were common. Autopsy studies revealed a wide spectrum of renal lesions, including renal amyloidosis, glomerulonephritis, tubulointerstitial nephritis and granulomatous disease ( 58 ).…”

Acute renal failure by rapidly progressive glomerulonephritis with IgA deposition in a patient concomitantly diagnosed with multibacillary Hansen's disease: a case report

“…6 The association between Hansen's and renal disease has been well documented in the literature in the form of manifestations of glomerulonephritis, tubulointerstitial disorders, and chronic kidney disease with secondary amyloidosis. 7 , 8 Renal impairment was found in 3.8% of the individuals enrolled in a large cohort study conducted by Daher et al ., with the following associated main risk factors: episodes of lepra reaction (erythema nodosum in particular), multibacillary disease, male gender, age, and time with the disease. Several urinary alterations have also been described (proteinuria in 4.8%; hematuria in 6.8%; leukocyturia in 10.4%).…”

“…The treatment of Hansen's disease with polychemotherapy and of lepra reactions with prednisone and thalidomide seems to improve renal function, particularly in patients with erythema nodosum leprosum. 7 , 10 …”

Desafios Na Adesão Ao Tratamento Da Hanseníase Segundo Enfermeiros Da Atenção Primária À Saúde

“…De acordo com Vieira (2008), o tratamento é de suma importância para que o paciente possa alcançar a cura, quebrando a fonte de infecção e acabando com a transmissão da doença, sendo então de papel estratégico no controle da endemia e para almejada eliminação da hanseníase.…”

“…Dessa maneira, devem ser sensibilizados e informados dos aspectos envolvidos na cadeia de transmissão da doença, diagnóstico, profilaxia, tratamento e cura. Segundo Dias e Pedrazzani (2008), os pacientes acometidos pela hanseníase, atualmente, ainda enfrentam preconceito e sofrem com o estigma da doença.…”