Assuntos
Injúria Renal Aguda/etiologia , Infecções por HIV/complicações , HIV-1/patogenicidade , Necrose Tubular Aguda/etiologia , Malária/complicações , Doença Aguda , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/parasitologia , Injúria Renal Aguda/patologia , Injúria Renal Aguda/virologia , Autopsia , Biópsia , República Democrática do Congo , Feminino , Infecções por HIV/mortalidade , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Necrose Tubular Aguda/mortalidade , Necrose Tubular Aguda/parasitologia , Necrose Tubular Aguda/patologia , Necrose Tubular Aguda/virologia , Malária/mortalidade , Malária/patologia , MasculinoRESUMO
Renal failure secondary to acute tubular necrosis is a common complication of severe Plasmodium falciparum malaria. The purpose of this report is to describe two cases of severe malaria featuring acute renal failure observed in young patients who had failed to comply with chemoprophylaxis. Occurrence of renal failure was delayed four to seven days in relation to the beginning of the malaria attack. Hemodialysis was required in one case. Both patients were successfully treated by quinine perfusion. The main pathophysiology mechanisms underlying acute tubular necrosis are obstruction of capillaries and post-capillary venules by infected red blood cells and activation of monocytes that release cytokines such as tumor necrosis factor. Other nonspecific mechanisms may come into play including hypovolemia, release of catecholamines and subsequent activation of the rennin-angiotensin system, complement activation, and rhabdomyolysis. Acute tubular necrosis is the main renal complication of Plasmodium falciparum malaria but latent forms of acute glomerulonephritis have also been documented. Prognosis is usually favorable depending mainly on early diagnosis and prompt treatment.
Assuntos
Injúria Renal Aguda/etiologia , Necrose Tubular Aguda/parasitologia , Malária Falciparum/complicações , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Adulto , Feminino , Humanos , Necrose Tubular Aguda/complicações , Necrose Tubular Aguda/fisiopatologia , Malária Falciparum/tratamento farmacológico , Masculino , Quinina/administração & dosagem , Quinina/uso terapêutico , Diálise RenalRESUMO
Renal involvement in parasitic infections are polymorphic. Plasmodium malariae often leads to membranoproliferative glomerulonephritis whereas acute tubular necrosis or post-infectious acute glomerulonephritis are observed with Plasmodium falciparum. Urogenital taxis of Schistosoma haematobium is responsible for frequency of chronic tubular and interstitial nephritis. Without specific treatment, the renal function progressively deteriorates and urological complications appear. Schistosoma mansoni mainly leads to mesangial and membranoproliferative glomerulonephritis. Membranoproliferative and membranous glomerulonephritis are reported with loasis. Onchocerca volvulus also leads to membranoproliferative glomerulonephritis and lipoid nephrosis. Renal involvement with Wuchereria bancrofti is rare. With leishmaniosis, it is often mild but more serious observations are described: acute glomerulonephritis, nephrotic syndrome or acute interstitial nephritis. Renal hydatic cysts are diagnosed in two or three per cent of cases. Surgery is the only treatment. Immunosuppressive or antimalarial treatments seem to be ineffective in the outcome of chronic glomerulonephritis.