Renal disease in typhoid fever: some immunological aspects

ABSTRACT

The occurrence of renal disease was correlated with immunological events in acute, recovery, and convalescent stages of typhoid fever in 24 consecutively treated patients. Transient abnormal urinalysis was quite common 59% of the patients had 2+ or greater proteinuria, amounting to 1.0 gm/ 24 hours in half of this group Approximately one-third of the patients with typhoid fever had significant hematuria BUN was elevated in 20% of the patients; and two patients developed classical acute tubular necrosis. Serum complement levels [C3] were significantly reduced in patients with renal disease during the acute stage [P<0.01] and increased to normal levels in the recovery stage. All immunoglobulins were significantly elevated to above control levels in patients with and without renal disease in all three stages. The percentage of B cells was increased and T cells were reduced significantly in the acute stage [P<0.01] except in patients with renal disease. However, in this group the percentage of T cells was significantly increased in the first and the second stages of the illness [P<0.005]. In the acute stage, IgA levels were significantly reduced in patients with renal disease compared to patients without renal involvement [P<0.025]. Renal biopsies in six patients with clinical and laboratory evidence of renal disease showed minimal proliferative changes as well as mild diffuse deposits of IgG, C3 and C4. It appears that renal involvment in typhoid fever commonly occurs as a transient glomerular or tubular disease, the glomerular disease being mild and associated with a decrease in serum complement levels. The immunological events associated with endemic [1,2] as well as experimental [3] typhoid fever are well known. The occurrence of transient glomerular disease [4,5], and acute renal failure due to hemolysis in typhoid fever has been the subject of a few brief reports [6-9]. However, no systematic study of the immunological events in relation to the occurrence of renal disease has been carried out. In addition, serum complement levels [C3c] have been variously reported as being normal or raised in different groups of patients [1,3,5,8] Typhoid fever, a common disease in Iran, has not been intensively studied. In this prospective study we report on the immunological events in different stages of typhoid fever as well as the occurrence of renal disease, and the correlation between immunological events and the occurrence of renal disease