Spectrum Of Renal Disease In Visceral Leishmaniasis

Abstract

Background: Renal involvement in Visceral Leishmaniasis has been reported in the form of proteinuria, microscopic haematuria, acute renal failure and histologic abnormalities in kidney biopsy. However, renal disease in Visceral Leishmaniasis is not widely documented from India, despite kala-azar being endemic in this country. Material methods: We have studied incidence and spectrum of clinical renal disease in patients with Visceral Leishmaniasis (VL). This study included 240 (Male: 154 and Female: 86) patients with parasitological confirmed diagnosis of VL over a period of two years (April 2002 – April 2004). The presence of oliguria, edema, proteinuria, elevated serum creatinine and haematuria either alone or in combination were taken as evidence of clinical renal disease. Renal tissue under light microscope was studied in six cases. Observation: The renal involvement was documented in 37/240 (15%) patients. The age (Male:32; Female:05) of the patient ranged between 15-36 years. The spectrum of renal diseases included; proteinuria in the range of 1-2 gm/day (15%), abnormal urinary sediment (4%), edema (9%) and acute renal failure (15%) of cases. Dialytic support was not needed. All patients received Amphotericin B (1.0 mg per kg body wt.) as anti-leishmanial treatment for 15 infusions. Renal histology in six patients revealed; ATN (4), AIN (01) and thrombotic microangiopathy in (01) patients. Glomerular lesions were not observed in our study. There was no mortality. Conclusion: Renal disease can occur during the course of Visceral Leishmaniasis. They were of mild nature and reversible with treatment of Kala-azar without specific treatment. Acute renal failure is mostly related to prerenal factors and overall renal disease carry good prognosis in patient with Visceral Leishmaniasis.