Renal involvement in leishmaniasis: a review of the literature

Abstract

Leishmaniasis, an infectious disease endemic in tropical, Asian and southern European countries, is caused by obligate intramacrophage protozoa and is transmitted through the bite of infected female sandflies. More than 20 leishmanial species are responsible for four main clinical syndromes: cutaneous leishmaniasis; mucocutaneous leishmaniasis; visceral leishmaniasis, also known as kala-azar, and post-kala-azar dermal leishmaniasis. Visceral leishmaniasis can present with varying clinical features and the kidney can also be involved. Both glomerular and tubular function can be altered and patients can develop proteinuria, haematuria, abnormalities in urinary concentration and acidification and acute and chronic renal insufficiency. Not only the disease itself but also the therapy administered might be responsible for the renal involvement in kala-azar. Indeed, some of the agents with efficiency against visceral leishmaniasis, such as pentavalent antimonial drugs, amphotericin B, pentamidine, miltefosine, paromomycin and simataquine, may be associated with a high risk of renal toxicity. In this article, the literature on renal involvement in visceral leishmaniasis is reviewed.

Preliminary Study on Tubuloglomerular Dysfunction and Evidence of Renal Inflammation in Patients with Visceral Leishmaniasis

“…1,2 VL can involve multiple organs, including the kidneys, by different and complex mechanisms, which may lead to tubulointerstitial and glomerular changes. 3,4 Interstitial involvement is more pronounced, and it is presented mainly through tubular changes as urinary acidification deficit and reduction in urinary concentration capacity. 5,6 In humans, renal involvement is usually caused by subclinical inflammatory interstitial infiltrate induced by the parasite, and discrete changes may also occur in glomerular basal membrane.…”

Treatment of American tegumentary leishmaniasis in special populations: a summary of evidence

“…A recent literature review on renal involvement in VL suggests that SbV, amphotericin B, pentamidine, miltefosine, paromomycin and sitamaquine may be associated with a high risk of renal toxicity 70 .…”

Nephrotic syndrome in a patient with visceral leishmaniasis: a case report

“…It is caused by Leishmania donovani [1]. About 40-60% of patients with visceral leishmaniasis have some form of renal involvement [2]. Visceral leishmaniasis affects both glomerular and tubular functions secondary to immune mediated injury as well as due to direct toxic effects by the pathogen itself.…”

“…Visceral leishmaniasis affects both glomerular and tubular functions secondary to immune mediated injury as well as due to direct toxic effects by the pathogen itself. Clinical features range from asymptomatic proteinuria, pyuria, microscopic haematuria, mild to moderate renal impairment and acute kidney injury [2]. Renal impairment could be due to multiple causes such as anaemia, hypoalbuminaemia, hypovolaemia and direct renal toxicity.…”