Abstract: TH-PO127

Glomerulopathies Secondary to Schistosomiasis: Histological Forms and Follow-Up

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Dias, Cristiane B., University of Sao Paulo, Brazil, São Paulo, Brazil
  • Jorge, Lectícia, University of São Paulo, São Paulo, Brazil
  • Testagrossa, Leonardo A., University of São Paulo, São Paulo, Brazil
  • Malheiros, Denise M., University of Sao Paulo, Sao Paulo, Brazil
  • Woronik, Viktoria, None, Salvador, Brazil
  • Neves, Precil D, University of S?o Paulo, S?o Paulo, Brazil
  • Bridi, Ramaiane A, University of São Paulo, São Paulo, Brazil
Background

Schistosomiasis mansoni (MS) is a parasitosis caused by Schistosoma mansoni that is endemic in several Brazilian states. Gastrointestinal involvement is the most frequent, but the kidney can also be injured, especially in the form of glomerulopathies. The aim of this study is to show the MS-related glomerulopathies and evaluation of the long-term follow-up

Methods

Evaluation of clinical data and renal biopsies of patients diagnosed with MS-related glomerulopathies in the period 1992-2017, in addition to clinical-evolutionary follow-up.

Results

Twenty eight patients, predominantly male (78.5%), white (64.2%), median age 38 (33; 44), all cases from the endemic area, most of them from Bahia (32,2%). The most common form of MS diagnosis was through fecal examination (94%), and 60.7% presented the hepatosplenic form of the disease. The most common clinical presentation was mixed syndrome (64.3%), with Cr: 1.51 ± 0.77mg / dL, MDRD: 69.3 ± 39ml / min / 1.73m2, 24h proteinuria: 6.56 ± 3.5g, serum albumin: 2.35 ± 0.91g / dL, low serum complement in 42.8% of patients. The distribution of the histological diagnoses to renal biopsy was: membranoproliferative glomerulonephritis (MPGN) 60.7%; focal segmental glomerulosclerosis (FSGS) 21.4%; membranous nephropathy 10.7% and proliferative mesangial 7.2%. The patients' follow-up time was 70 (14-124) months, after which 32.1% of the patients had started dialysis. Comparing the patients with MPGN vs non-MPGN, they differed in proteinuria of 24h (g) (5.19 vs 8.67, p = 0.04) and serum albumin (g / dL) (2.6 vs 1.0 , P = 0.04), frequency of hypertension (%) (70.5 vs 9.0, p = 0.002) and hematuria (%) (94.1 vs 45.4, p = 0.007). Comparing patients that evolved and did not evolve to dialysis, they differed in the initial creatinine (1.99 vs 1.28, p = 0.05), MDRD (55/78 , P = 0.03), renal response to anti-parasitic use (%) (0 vs 77, p = 0.0007) and follow-up time (months) (45.7 vs 9.7, p = 0, 03).

Conclusion

The glomerulopathies secondary to MS are still a reality in Brazilian daily life. Histological presentation as GNMP did not determine a worse prognosis for the patients in this series, but rather the severity of the initial clinical presentation and non-response to the use of antiparasitics.