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Leprosy Nephropathy

  • Verônica Verleine Hörbe Antunes
  • Elvino Barros
  • Alice Maria Costa Martins
  • Gdayllon Cavalcante Meneses
  • Elizabeth De Francesco Daher
  • Geraldo Bezerra da Silva JuniorEmail author
Chapter
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Abstract

Leprosy is mainly characterized by integumentary and peripheral nervous system lesions, and renal involvement in this disease was first described in autopsy findings in the beginning of the twentieth century. Renal lesions are found in all forms of leprosy, being more frequent in the multibacillary form. The kidneys are the most affected organs in secondary amyloidosis that develops in leprosy. The exact mechanism leading to the development of leprosy-associated glomerulopathy is not completely understood. Mycobacterium leprae does not seem to be directly involved, although it has been found in some patients’ glomeruli. Reduction of glomerular filtration rate (GFR) has been observed in some series in approximately 50% of cases. Patients with the multibacillary form had significantly lower GFR and urinary concentration capacity than those with the paucibacillary forms. Urinary acidification deficit is found in 1/3 of paucibacillary and multibacillary cases. Reduced urinary concentration capacity is found in more than 2/3 of cases. Acute kidney injury (AKI) has been associated with leprosy glomerulonephritis and acute tubular necrosis secondary to other phenomena, such as ischemic injury or nephrotoxicity caused by drugs used in the treatment, such as rifampin and nonsteroidal anti-inflammatory drugs. Treatment includes specific chemotherapy, suppression of reaction outbreaks, prevention of physical disabilities, physical, and psychosocial rehabilitation and seems to improve leprosy nephropathy.

Keywords

Leprosy Hansen disease Mycobacterium leprae Neglected diseases Acute kidney injury Chronic kidney disease Biomarkers 

References

  1. 1.
    Renault CA, Ernst JD. Mycobacterium leprae. In: Mandell: Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010. p. 3165–76.CrossRefGoogle Scholar
  2. 2.
    Silva Junior GB, Daher EF, Pires Neto RJ, Pereira EDB, Meneses GC, Araújo SMHA, Barros EJG. Leprosy nephropathy: a review of clinical and histopathological features. Rev Inst Med Trop São Paulo. 2015;57(1):15–20.CrossRefGoogle Scholar
  3. 3.
    Talhari C, Talhari S, Penna GO. Clinical aspects of leprosy. Clin Dermatol. 2015;33(1):26–37.CrossRefGoogle Scholar
  4. 4.
    Grzybowski A, Nita M. Leprosy in the Bible. Clin Dermatol. 2016;34(1):3–7.CrossRefGoogle Scholar
  5. 5.
    World Health Organization. Leprosy elimination. Epidemiology. Available at: http://www.who.int/lep/epidemiology/en/. Accessed 28/03/2018.
  6. 6.
    Brasil, Ministério da Saúde. Secretaria de Vigilância em Saúde. Boletim Epidemiológico – Hanseníase. vol. 49, n. 4, 2018. Available at: http://portalarquivos2.saude.gov.br/images/pdf/2018/janeiro/31/2018-004-Hanseniase-publicacao.pdf. Accessed 28/03/2018.
  7. 7.
    Brasil, Ministério da Saúde. Indicadores epidemiológicos e operacionais de hanseníase Brasil 2001–2016. Available at http://portalarquivos2.saude.gov.br/images/pdf/2017/julho/10/Indicadores-epidemiol%2D%2Dgicos-e-operacionais-de-hansen%2D%2Dase.%20Brasil,%202001-.pdf. Accessed 28/03/2018.
  8. 8.
    Veronesi-Focaccia. Tratado de Infectologia. 5ª ed. São Paulo: Editora Atheneu; 2015.Google Scholar
  9. 9.
    Kean B, Childress ME. A summary of 103 autopsies on leprosy patients on the Isthmus of Panama. Int J Lepr. 1942;10:51–9.Google Scholar
  10. 10.
    Mitsuda K, Ogawa M. A study of 150 autopsies on cases of leprosy. Int J Lepr. 1937;5:53–60.Google Scholar
  11. 11.
    Silva Junior GB, Daher EF. Renal involvement in leprosy: retrospective analysis of 461 cases in Brazil. Braz J Infect Dis. 2006;10(2):107–12.CrossRefGoogle Scholar
  12. 12.
    Daher EF, Silva GB Jr, Cezar LC, Lima RS, Gurjão NH, Mota RM, et al. Renal dysfunction in leprosy: a historical cohort of 923 patients in Brazil. Trop Dr. 2011;41(3):148–50.CrossRefGoogle Scholar
  13. 13.
    Silva Junior GB, Barbosa OA, Barros RM, dos Reis Carvalho P, Mendoza TR, Barreto DM, et al. Amiloidose e insuficiência renal crônica terminal associada à hanseníase. Rev Soc Bras Med Trop. 2010;43(4):474–6.CrossRefGoogle Scholar
  14. 14.
    Grover S, Bobhate SK, Chaubey BS. Renal abnormalities in leprosy. Lepr India. 1983;55:286–91.PubMedGoogle Scholar
  15. 15.
    Peter KS, Vijayakumar T, Vasudevan DM, Devi KR, Mathew MT, Gopinath T. Renal involvement in leprosy. Lepr India. 1981;53:163–78.PubMedGoogle Scholar
  16. 16.
    Sengupta U, Ramu G, Sinha S, Ramanathan VD, Desikan KV. Immunoglobulins in the urine of leprosy patients. Int J Lepr Other Mycobact Dis. 1983;51:409–10.PubMedGoogle Scholar
  17. 17.
    Singhal PC, Chugh KS, Kaur S, Malik AK. Acute renal failure in leprosy. Int J Lepr Other Mycobact Dis. 1977;45:171–4.PubMedGoogle Scholar
  18. 18.
    Meneses GC, Libório AB, Daher EF, Silva Juniof GV, Costa MF, Pontes MA, Martins AM. Urinary monocyte chemotactic protein-1 (MCP-1) in leprosy patients: increased risk for kidney damage. BMC Infect Dis. 2014;14:451.CrossRefGoogle Scholar
  19. 19.
    Oliveira RA, Silva GB Jr, Souza CJ, Vieira EF, Mota RM, Martins AM, et al. Evaluation of renal function in leprosy: a study of 59 consecutive patients. Nephrol Dial Transplant. 2008;23(1):256–62.CrossRefGoogle Scholar
  20. 20.
    Polito MG, Moreira SR, Nishida SK, Mastroianni KG. It is time to review concepts on renal involvement in leprosy: pre- and post-treatment evaluation of 189 patients. Ren Fail. 2015;37(7):1171–4.CrossRefGoogle Scholar
  21. 21.
    Daher EF, Silva Junior GB. Nefropatia nas doenças tropicais. In: Riella MC, editor. Princípios de Nefrologia e Distúrbios Hidreletrolíticos. 6ª ed. Rio de Janeiro: Guanabara-Koogan; 2018. p. 553–81.Google Scholar
  22. 22.
    Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. Guia de Vigilância em Saúde: volume 2/Ministério da Saúde, Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. – 1. ed. atual. Brasília: Ministério da Saúde; 2017.Google Scholar
  23. 23.
    Coppola M, van den Eeden SJF, Robbins N, Wilson L, Franken KLMC, Adams LB, et al. Vaccines for leprosy and tuberculosis: opportunities for shared research, development, and application. Front Immunol. 2018;9:308.CrossRefGoogle Scholar
  24. 24.
    Kumar S. India resurrects forgotten leprosy vaccine. Science. 2017;356(6342):999.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Verônica Verleine Hörbe Antunes
    • 1
  • Elvino Barros
    • 2
  • Alice Maria Costa Martins
    • 3
  • Gdayllon Cavalcante Meneses
    • 4
  • Elizabeth De Francesco Daher
    • 5
  • Geraldo Bezerra da Silva Junior
    • 6
    Email author
  1. 1.Division of NephrologyHospital de Clinicas de Porto Alegre, Federal University of Rio Grande do SulPorto AlegreBrazil
  2. 2.School of MedicineFederal University of Rio Grande do SulPorto AlegreBrazil
  3. 3.Department of Clinical and Toxicological Analyses, Post-Graduation Program in Pharmaceutical SciencesFederal University of CearaFortalezaBrazil
  4. 4.Department of Internal Medicine, Post-Graduation Program in Medical SciencesFederal University of CearaFortalezaBrazil
  5. 5.Post-Graduation Program in Medical Sciences, School of MedicineFederal University of CearaFortalezaBrazil
  6. 6.Post-Graduation Programs in Public Health and Medical Sciences, School of MedicineUniversity of FortalezaFortalezaBrazil

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