It is time to review concepts on renal involvement in leprosy: pre- and post-treatment evaluation of 189 patients

Abstract

Background: Functional and morphological renal lesions have been widely described in leprosy for decades. Nevertheless few studies have assessed renal function pre-and during treatment after the advent of multidrug therapy (MDT). Methods: This is a prospective study involving 189 consecutive patients, with all forms of leprosy (Ridley-Jopling scale). Laboratory (serum urea and creatinine, estimated GFR, urinalysis, microalbuminuria, urinary RBP) and clinical features of renal disease were evaluated previously and after onset (3 and 8 months later) of MDT. Results: One hundred and eighty-nine patients (M 1.8: F 1; mean age 44 ± 16 years) were included just after diagnosis of leprosy and before the introduction of MDT. Mean time until manifestation of symptoms and/or signs of leprosy was 29 ± 56 months (25 days-480 months). Microhematuria and microalbuminuria were detected in 7.5% and 9.6% of the cases, respectively. Elevated serum creatinine was detected in 34% pre-MDT; this was statistically more frequent in males, hypertensive and frequent users of non-steroidal anti-inflammatory drugs (NSAID), as well as in patients with erythema nodosum lepromatosum, 45.5% by the time of diagnosis, 18% after 3 months and 9% after 8 months of MDT (p ¼ 0.039). Conclusions: Our results suggest that functional renal lesions in leprosy are currently mild and predominantly of glomerular origin, in opposition to the severe involvement described in the past. This improved outcome of renal disease secondary to leprosy is possibly due to the advent of MDT and effective treatment of episodes of reaction, leading to shorter periods of active infectious disease.

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

“…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 …”

Neglected Tropical Diseases with an Impact on Kidney Function

“…AKI can also occur in leprosy and seems to be associated to glomerulonephritis complications or secondary to the use of nephrotoxic drugs, mainly anti-inflammatory drugs and rifampicin, which are used in leprosy therapeutic scheme. Leprosy nephropathy seems to have changed in recent years, becoming a milder disease, characterized by micro-hematuria and mild proteinuria, which tends to recover after specific treatment [78].…”

Endothelial activation is associated with albuminuria in multibacillary leprosy

“…Nevertheless, investigations on subclinical alterations and incipient renal damage during leprosy patients care have not been evaluated 4 . In addition, it is not clear if leprosy patients that suffer from other previous chronic diseases, like diabetes and hypertension, have a higher risk for renal diseases and other complications 5 .…”