Federico Gentile, Marida Martino, Luisa Santangelo, Paolo Giordano, Diletta Domenica Torres, Vincenza Carbone, Anna Maria Di Palma, Michele Rossini, Loreto Gesualdo, Paola Giordano, Mario Giordano

From Uganda to Italy: a case of nephrotic syndrome secondary to Plasmodium infection, Quartan malarial nephropathy and kidney failure

Malaria (M), the first parasitic infection, is sometimes associated withnephrotic syndrome (NS) in tropical areas. Kidney involvement during quartanmalaria is represented by immune-complex mediated glomerulonephritis(GN). Generally, NS develops several weeks after onset of quartan fever andits clinical course proceeds slowly to end-stage kidney disease (ESKD) evenafter eradication of the infection. We describe a case of Plasmodium malariaeassociated nephrotic syndrome and chronic proliferative glomerulopathyin a boy from Uganda. Renal biopsy revealed chronic proliferative GN withcapillary wall thickening producing a double contour, segmental sclerosis andtubular atrophy. Blood Giemsa smear contained rare ring-form trophozoitesand gametocytes of Plasmodium spp. This case highlights the importance ofobtaining remote travel histories from immigrants presenting with nephroticsyndrome especially due to the current immigration crisis in Europe. Malariahas low prevalence or less known in our continent and requires more medicalattention by European doctors.

PDF

___

1. Elsheikha HM, Sheashaa HA. Epidemiology, pathophysiology, management and outcome of renal dysfunction associated with plasmodia infection. Parasitol Res 2007; 101: 1183-1190.
2. Edington GM, Mainwaring AR. Nephropathies in West Africa. In: Mostofi FK, Smith DE (eds). The Kidney. Baltimore: Williams and Wilkins, 1966: 488.
3. Ehrich JH, Eke FU. Malaria-induced renal damage: facts and myths. Pediatr Nephrol 2007; 22: 626-637.
4. Gilles HM, Hendrickse RG. Nephrosis in Nigerian children: role of Plasmodium malariae, and effect of antimalarial treatment. Br Med J 1963; 2: 27-31
5. Kibukamusoke JW, Hutt MSR, Wilks NE. The nephrotic syndrome in Uganda and its association with quartan malaria. QJM Int J Med 1967; 36: 393- 408
6. Eiset AH, Wejse C. Review of infectious diseases in refugees and asylum seekers-current status and going forward. Public Health Rev 2017; 38: 22.
7. Abstracts from the 2017 Society of General Internal Medicine Annual Meeting. J Gen Intern Med 2017; 32(Suppl 2): 83-808. (Slinchenkova O, Coyle C. Severe malaria: how to predict mortality-Scientific Abstracts S589-S590).