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 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 [2,3]. 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) [4-8].
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 .
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- 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
- SUMMARY AND RECOMMENDATIONS