ESPN 50th Annual Meeting

ESPN 2017


 
FROM UGANDA TO ITALY: A CASE OF NEPHROTIC SYNDROME SECONDARY TO PLASMODIUM INFECTION. QUARTAN MALARIA NEPHROPATHY AND KIDNEY FAILURE
FEDERICO GENTILE 1 MARIDA MARTINO 1 LUISA SANTANGELO 1 DILETTA DOMENICA TORRES 1 VINCENZA CARBONE 1 ANNA MARIA DI PALMA 2 LORETO GESUALDO 2 MARIO GIORDANO 1

1- Pediatric Nephrology and dialysis Unit, Pediatric Hospital Giovanni XXIII, Bari
2- Department of Emergency and organ Transplantation - Nephrology, dialysis and transplantation Unit, University of Bari Aldo Moro, Bari, Italy
 
Introduction:

Malaria (M), the first parasitic infection, is sometimes associated with nephrotic syndrome (NS) in tropical areas. Kidney involvement during quartan malaria is represented by immune-complex mediated glomerulonephritis (GN). Generally NS develops several weeks after onset of quartan fever and its clinical course proceeds slowly to end-stage kidney disease (ESKD) even after eradication of the infection. 

Material and methods:

A 17-year-old Ugandan boy was transferred in Italy, as part of a humanitarian project, to treat ESKD with onset 13 months before as NS. In Uganda, the patient received steroids and immunosuppressive therapy with poor results and some dialysis sessions. On admission in our department, clinical examination  showed a pale, febrile and edematous boy with hypophonesis in the right hemithorax and a malodorous purulent secretion from exit site of central venous catheter.

 

Results:

Laboratory tests revealed massive proteinuria (11,9 g/24h) and laboratory findings of kidney failure: serum creatinine 4,0 mg/dl and glomerular filtration rate 21 mL/min./1.73m2. There was also leukocytosis (WBC 26,1 x 103/µL) and anemia (Hb 8,44 g/dl) and high serum c-reactive protein (213 mg/dl). The peripheral blood smear showed rare ring-form trophozoites and gametocytes of Plasmodium spp. Abdominal ultrasound showed small and hyperechoic kidneys; chest CT scan showed copious left pleural effusion with partial lung collapse. Renal biopsy revealed chronic proliferative GN with capillary wall thickening producing a double contour, segmental sclerosis and tubular atrophy. On immunofluorescence, granular deposits of IgA and C3 were observed on mesangium.  The patient was treated with atovaquone/proguanil for 3 days; pleural effusion required the placement of pleural drainage for 3 weeks. Actually he is inserted in a dialysis/kidney transplant.

Conclusions:

This case highlights the importance of obtaining remote travel histories from immigrants presenting with nephrotic syndrome especially for the current immigration crisis in Europe. Malaria has low prevalences or is slightly known in our continent and requires more medical attention by European doctors.