Schistosoma mansoni infection as a trigger to collapsing glomerulopathy in a patient with high-risk APOL1 genotype

Schistosoma mansoni schistosomiasis (SM) remains a public health problem in Brazil. Renal involvement is classically manifested as a glomerulopathy, most often membranoproliferative glomerulonephritis or focal and segmental glomerulosclerosis. We report a case of collapsing glomerulopathy (CG) assoc...

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Published in:PLoS neglected tropical diseases 2020-10, Vol.14 (10), p.e0008582-e0008582
Main Authors: Neves, Precil D, Bridi, Ramaiane A, Ramalho, Janaína A, Jorge, Lectícia B, Watanabe, Elieser H, Watanabe, Andreia, Yu, Luis, Woronik, Viktoria, Pinheiro, Rafaela B, Testagrossa, Leonardo A, Cavalcante, Lívia B, Malheiros, Denise M, Dias, Cristiane B, Onuchic, Luiz F
Format: Article
Language:English
Subjects:
Abdomen
Adult
Albumins
Animals
Antibodies
Antineutrophil cytoplasmic antibodies
Antinuclear antibodies
Apolipoprotein L1 - genetics
Apolipoproteins
Biology and Life Sciences
Biopsy
Brazil
Case reports
Case studies
Cholesterol
Collapse
Complications and side effects
Creatinine
Diagnosis
Edema
End-stage renal disease
Genetic aspects
Genetics
Genotype & phenotype
Genotypes
Glomerulonephritis
Health aspects
Hematuria
Hemoglobin
Hepatitis
Hepatitis B surface antigen
Hepatitis C
HIV
Human immunodeficiency virus
Humans
Hypertension
Immunoglobulin G
Immunoglobulins
Infections
Kidney diseases
Kidney Failure, Chronic - complications
Kidney Glomerulus - pathology
Kidneys
Laboratories
Laboratory tests
Lipoproteins
Male
Medicine
Medicine and Health Sciences
Nephrology
Pathogenesis
Pathogens
Pathology
People and places
Platelets
Pleural effusion
Praziquantel
Prednisone
Proteinuria
Public health
Rheumatoid factor
Risk
Risk management
Schistosoma mansoni
Schistosomiasis
Schistosomiasis mansoni - complications
Schistosomiasis mansoni - genetics
Schistosomiasis mansoni - pathology
Serum
Symposium
Tropical diseases
Ultrasonic imaging
Urea
Viruses
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Description
Summary:Schistosoma mansoni schistosomiasis (SM) remains a public health problem in Brazil. Renal involvement is classically manifested as a glomerulopathy, most often membranoproliferative glomerulonephritis or focal and segmental glomerulosclerosis. We report a case of collapsing glomerulopathy (CG) associated with SM and high-risk APOL1 genotype (HRG). A 35-year-old male was admitted for hypertension and an eight-month history of lower-limb edema, foamy urine, and increased abdominal girth. He had a recent diagnosis of hepatosplenic SM, treated with praziquantel, without clinical improvement. Laboratory tests revealed serum creatinine 1.89mg/dL, blood urea nitrogen (BUN) 24mg/dL, albumin 1.9g/dL, cholesterol 531mg/dL, low-density lipoprotein 426mg/dL, platelets 115000/mm3, normal C3/C4, antinuclear antibody (ANA), rheumatoid factor (RF), and antineutrophil cytoplasmic antibodies (ANCA), negative serologies for hepatitis C virus (HCV) and human immunodeficiency virus (HIV), HBsAg negative and AntiHBc IgG positive, no hematuria or leukocyturia, 24 hour proteinuria 6.56g and negative serum and urinary immunofixation. Kidney biopsy established the diagnosis of CG. A treatment with prednisone was started without therapeutic response, progressing to end-stage kidney disease 19 months later. Molecular genetics investigation revealed an HRG. This is the first report of CG associated with SM in the setting of an HRG. This case highlights the two-hit model as a mechanism for CG pathogenesis, where the high-risk APOL1 genotype exerts a susceptibility role and SM infection serves as a trigger to CG.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0008582