Schistosomiasis and glomerular disease
- Rashad S Barsoum, MD, FRCP, FRCPE
Rashad S Barsoum, MD, FRCP, FRCPE
- Emeritus Professor of Medicine
- Kasr El-Aini Medical School, Cairo University, Egypt
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Brad H Rovin, MD
Brad H Rovin, MD
- Section Editor — Glomerular Diseases
- Professor of Medicine and Pathology
- The Ohio State University College of Medicine
Human schistosomiasis is caused by infection with Schistosoma haematobium, S. mansoni, S. japonicum, S. mekongi, or S. intercalatum. The kidneys are important targets of schistosomal infection. There are several patterns of renal involvement in schistosomiasis, including the upstream sequelae of lower urinary tract pathology , immune-mediated glomerulonephritis , and oxidant-stress-mediated tubular injury [3,4]. Glomerular disease associated with schistosomiasis will be discussed here. Other issues related to schistosomiasis are presented separately. (See "Epidemiology, pathogenesis, and clinical manifestations of schistosomiasis" and "Diagnosis of schistosomiasis" and "Treatment and prevention of schistosomiasis".)
Like many other helminthic diseases , schistosomiasis may produce a broad spectrum of glomerular pathology. The incidence is unknown since many cases are subclinical or resolve spontaneously. In a village in Upper Egypt, for example, where S. haematobium was newly introduced as a result of changing irrigation methods, the majority of those who acquired the infection developed self-limited nephrotic-range proteinuria with biopsy-confirmed mesangioproliferative glomerulonephritis [6,7]. Similar glomerular lesions have also been described with recent S. mansoni or S. japonicum infection and usually resolve with antiparasitic treatment.
In contrast, persistent or progressive glomerular disease develops in approximately 10 to 15 percent of patients who usually have hepatic fibrosis due to chronic infection with S. mansoni (and occasionally S. haematobium) [2,8-11].
Several observations are compatible with a pathogenic role for the immune response to the parasite in the development of glomerulonephritis in affected patients:
●Glomerular lesions, similar to those described in humans, have been induced by experimental infection of many small and large animals [12,13].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Barsoum RS. Urinary schistosomiasis: review. J Adv Res 2013; 4:453.
- Barsoum RS. Schistosomal glomerulopathies. Kidney Int 1993; 44:1.
- Duarte DB, Vanderlei LA, Bispo RK, et al. Renal function in hepatosplenic schistosomiasis--an assessment of renal tubular disorders. PLoS One 2014; 9:e115197.
- Dkhil MA, Khalil MF, Bauomy AA, et al. Efficacy of Gold Nanoparticles against Nephrotoxicity Induced by Schistosoma mansoni Infection in Mice. Biomed Environ Sci 2016; 29:773.
- Barsoum RS. Tropical parasitic nephropathies. Nephrol Dial Transplant 1999; 14 Suppl 3:79.
- Ezzat E, Osman RA, Ahmet KY, Soothill JF. The association between Schistosoma haematobium infection and heavy proteinuria. Trans R Soc Trop Med Hyg 1974; 68:315.
- Ezzat E, Tohamy M, et al. Immunopathological study of glomerulonephritis associated with Schistosoma haematobium infection. In: Proceedings of the International Conference on Schistosomiasis, Cairo 1978. p.625.
- Soliman M, Abdel-Salam E, et al. Schistosomiasis haematobium glomerulopathy: a clinical or a pathological entity?. In: Abstracts of the 10th International Congress of Nephrology, London 1987. p.362.
- Chapter 10: Immunoglobulin A nephropathy. Kidney Int Suppl (2011) 2012; 2:209.
- Sobh MA, Moustafa FE, el-Housseini F, et al. Schistosomal specific nephropathy leading to end-stage renal failure. Kidney Int 1987; 31:1006.
- Nussenzveig I, De Brito T, Carneiro CR, Silva AM. Human Schistosoma mansoni-associated glomerulopathy in Brazil. Nephrol Dial Transplant 2002; 17:4.
- Houba V. Experimental renal disease due to schistosomiasis. Kidney Int 1979; 16:30.
- Eid RA, Al-Shraim M, El-Sayed F, Radad K. Ultrastructural changes of kidney in Schistosoma mansoni-infected mice. Ultrastruct Pathol 2017; 41:320.
- Hoshino-Shimizu S, De Brito T, Kanamura HY, et al. Human schistosomiasis: Schistosoma mansoni antigen detection in renal glomeruli. Trans R Soc Trop Med Hyg 1976; 70:492.
- Barsoum RS, Bassily S, Baligh OK, et al. Renal disease in hepatosplenic schistosomiasis: a clinicopathological study. Trans R Soc Trop Med Hyg 1977; 71:387.
- Barsoum R. The changing face of schistosomal glomerulopathy. Kidney Int 2004; 66:2472.
- Sobh MA, Moustafa FE, Sally SM, et al. Characterisation of kidney lesions in early schistosomal-specific nephropathy. Nephrol Dial Transplant 1988; 3:392.
- Barsoum RS, Sersawy G, Haddad S, et al. Hepatic macrophage function in schistosomal glomerulopathy. Nephrol Dial Transplant 1988; 3:612.
- van Marck EA, Deelder AM, Gigase PL. Effect of partial portal vein ligation on immune glomerular deposits in Schistosoma mansoni-infected mice. Br J Exp Pathol 1977; 58:412.
- Sobhy E, Ali MI, et al. B-lymphocyte subpopulations in schitosomal glomerulopathy. Med J Cairo Univ 2001; 69:507.
- Pearce EJ, MacDonald AS. The immunobiology of schistosomiasis. Nat Rev Immunol 2002; 2:499.
- Abdel-Badie I, Barsoum RS. B-lymphocyte immunoglobulin surface expression in schistosomal glomerulopathy. Med J Ahmed Maher Hosp 1999; 1:1.
- Barsoum R, Nabil M, Saady G, et al. Immunoglobulin-A and the pathogenesis of schistosomal glomerulopathy. Kidney Int 1996; 50:920.
- Gonçalves FO, Fontes TM, Canuto AP. Schistosoma mansoni associated glomerulopathy with IgA mesangial deposits: case report. J Bras Nefrol 2017; 39:86.
- Thomas MA, Frampton G, Isenberg DA, et al. A common anti-DNA antibody idiotype and anti-phospholipid antibodies in sera from patients with schistosomiasis and filariasis with and without nephritis. J Autoimmun 1989; 2:803.
- Hillyer GV. Deoxyribonucleic acid (DNA) and antibodies to DNA in the serum of hamsters and man infected with schistosomes. Proc Soc Exp Biol Med 1971; 136:880.
- Kayange NM, Smart LR, Downs JA, et al. The influence of HIV and schistosomiasis on renal function: a cross-sectional study among children at a hospital in Tanzania. PLoS Negl Trop Dis 2015; 9:e0003472.
- Barsoum RS. Parasitic kidney disease: milestones in the evolution of our knowledge. Am J Kidney Dis 2013; 61:501.
- Isnard A, Chevillard C. Recent advances in the characterization of genetic factors involved in human susceptibility to infection by schistosomiasis. Curr Genomics 2008; 9:290.
- McManus DP, Ross AG, Williams GM, et al. HLA class II antigens positively and negatively associated with hepatosplenic schistosomiasis in a Chinese population. Int J Parasitol 2001; 31:674.
- Hafez MH, Zaatar M, et al. HLA A1, B35, DR 1,4 and nephrotic syndrome in adult Egyptians. Med J Cairo Univ 1991; 59:947.
- Lopes AA, Port FK, James SA, et al. Race and glomerulonephritis in patients with and without hepatosplenic Schistosomiasis mansoni. Clin Nephrol 2002; 58:333.
- Barsoum RS. Schistosomal glomerulopathy: selection factors. Nephrol Dial Transplant 1987; 2:488.
- el-Mawla NG, el-Bolkainy MN, Khaled HM. Bladder cancer in Africa: update. Semin Oncol 2001; 28:174.
- Mhimbira F, Hella J, Said K, et al. Prevalence and clinical relevance of helminth co-infections among tuberculosis patients in urban Tanzania. PLoS Negl Trop Dis 2017; 11:e0005342.
- Anchang-Kimbi JK, Elad DM, Sotoing GT, Achidi EA. Coinfection with Schistosoma haematobium and Plasmodium falciparum and Anaemia Severity among Pregnant Women in Munyenge, Mount Cameroon Area: A Cross-Sectional Study. J Parasitol Res 2017; 2017:6173465.
- Degarege A, Degarege D, Veledar E, et al. Plasmodium falciparum Infection Status among Children with Schistosoma in Sub-Saharan Africa: A Systematic Review and Meta-analysis. PLoS Negl Trop Dis 2016; 10:e0005193.
- el-Hawey AM, Abou-Taleb SA, Mohamed NH, et al. A clinico-parasitological and immunological studies (sic) on concomitant mansoniasis and filariasis in Egypt. J Egypt Soc Parasitol 1986; 16:95.
- Ott BR, Libbey NP, Ryter RJ, Trebbin WM. Treatment of schistosome-induced glomerulonephritis. A case report and review of the literature. Arch Intern Med 1983; 143:1477.
- Hsiao A, Toy T, Seo HJ, Marks F. Interaction between Salmonella and Schistosomiasis: A Review. PLoS Pathog 2016; 12:e1005928.
- Barnhill AE, Novozhilova E, Day TA, Carlson SA. Schistosoma-associated Salmonella resist antibiotics via specific fimbrial attachments to the flatworm. Parasit Vectors 2011; 4:123.
- Secor WE. Interactions between schistosomiasis and infection with HIV-1. Parasite Immunol 2006; 28:597.
- Martinelli R, Noblat AC, Brito E, Rocha H. Schistosoma mansoni-induced mesangiocapillary glomerulonephritis: influence of therapy. Kidney Int 1989; 35:1227.
- Neves PD, Bezerra KS, Silveira MA, et al. Schistosoma mansoni and membranous nephropathy. Kidney Int 2016; 89:959.
- Weerakoon KG, Gobert GN, Cai P, McManus DP. Advances in the Diagnosis of Human Schistosomiasis. Clin Microbiol Rev 2015; 28:939.
- Tsang VC, Wilkins PP. Immunodiagnosis of schistosomiasis. Immunol Invest 1997; 26:175.
- Qian Z, Lu P, Wang Z, et al. Isolation and specific detection of two major schistosoma gut-associated circulating antigens. Chin Med J (Engl) 2001; 114:614.
- Dash SC, Bhowmik D. Glomerulopathy with liver disease: patterns and management. Saudi J Kidney Dis Transpl 2000; 11:414.
- Mahmoud AA. Praziquantel for the treatment of helminthic infections. Adv Intern Med 1987; 32:193.
- Bassily S, Farid Z, Barsoum RS, et al. Renal biopsy in Schistosoma-Salmonella associated nephrotic syndrome. J Trop Med Hyg 1976; 79:256.
- CLINICOPATHOLOGIC MANIFESTATIONS
- Clinical features
- - Salmonella coinfection
- - Hepatitis B virus (HBV) coinfection
- - Hepatitis C virus (HCV) coinfection
- - Human immunodeficiency virus (HIV) coinfection
- Histologic classification
- Documentation of schistosomal infection
- Role of kidney biopsy
- DIFFERENTIAL DIAGNOSIS
- THERAPY AND PROGNOSIS
- Class I
- Class II
- Classes III to V
- Class VI
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- SUMMARY AND RECOMMENDATIONS