Membranoproliferative Glomerulonephritis due to Visceral Leishmaniasis in an HIV Patient

Abstract

Patient: Male, 47Final Diagnosis: Membranoproliferative glomerulonephritisSymptoms: Nephrotic syndromeMedication: —Clinical Procedure: Renal biopsySpecialty: NephrologyObjective:Rare diseaseBackground:Visceral leishmaniasis is an important opportunistic disease in HIV-positive patients. The information available on the effects of such co-infection in the kidney is limited. We describe a patient with HIV/leishmania coinfection who developed nephrotic syndrome and membranoproliferative glomerulonephritis. As far as we know, only 2 cases of this nephropathy in HIV/leishmania coinfection have been reported.Case Report:A 47-year-old man developed nephrotic syndrome. He had been diagnosed with HIV infection and visceral leishmaniasis and was treated with antiretroviral therapy, antimonial compounds, liposomal amphotericin B and miltefosine, but the leishmania followed a relapsing course.Renal biopsy disclosed membranoproliferative glomerulonephritis and leishmania amastigotes were seen within glomerular capillary lumens. He was given miltefosine and liposomal amphotericin B but the leishmaniasis persisted. Stage 3B chronic renal disease and nephrotic range proteinuria tend to become stable by 15-month follow-up.Conclusions:Our case illustrated some aspects of leishmaniasis in HIV patients: its relapsing course, the difficulties in therapy, and the renal involvement.

Leishmaniasis-Associated Membranoproliferative Glomerulonephritis With Massive Complement Deposition

“…The glomerular deposition of a large amount of complement factors of the classical pathway and absence of immune deposits are suggestive of leishmania-driven fluid-phase activation of classical pathway of complement, similar to that seen in C3 glomerulopathy, where there is fluid-phase activation of the alternative pathway of complement. 29 The laboratory finding of low C3 levels was consistent with overall activation of the complement pathway. However, normal levels of C4 were contrary to the expected low C4 levels seen in activation of the classical pathway of complement.…”

“…A search of the literature revealed a case similar to our case in which the authors described a 47-year-old man with HIV and leishmaniasis. 29 The kidney biopsy showed an MPGN pattern of injury, and the immunofluorescence was characterized by bright C3 and C1q, and negative Igs. Electron microscopy was not reported.…”

Continuous hypergammaglobulinemia and proteinuria after the recovery of the visceral Leishmaniasis: a case report

“…Pathologically, both glomerulonephritis [ 5 ] and interstitial nephritis [ 6 ] have been reported. Glomerular involvement included mesangial proliferative glomerulonephritis [ 7 ], focal segmental glomerulosclerosis [ 8 ], and membranoproliferative glomerulonephritis [ 9 ]. Other kidney impairment might attribute to co-morbidities, such as viral infection [ 10 ] or side effects of drugs [ 11 ].…”

Visceral leishmaniasis and glomerulonephritis: A case report

“…VL can present with varying clinical features, and the involvement of kidney is known to alter tubular and glomerular function, resulting in proteinuria, hematuria, acidification defect and urinary concentration abnormalities. [4] Renal involvement in VL can result in interstitial, glomerular and vascular damage;[6] interstitial nephritis;[67] glomerular sclerosis[8] and membranoproliferative glomerulonephritis,[491011] which lead to nephritic syndrome, acute or chronic renal failure. [4] Direct invasion of the renal parenchyma by the parasite results in kidney damage, especially among immunocompromised patients.…”