title: Glomerulonephritis in schistosomiasis mansoni: a time to reappraise.
abstract: BACKGROUND
  The current prevalence of glomerulonephritis in patients with hepatosplenic schistosomiasis mansoni in Brazil was evaluated.
  
  
  METHODS
  Sixty three patients (mean age 45.5 ± 11 years) attending the outpatient infectious disease clinic of a University Hospital in Belo Horizonte, Brazil, from 2007 to 2009, were consecutively examined and enrolled in the present investigation. Diagnosis of hepatosplenic schistosomiasis was based on epidemiological, clinical and parasitological data and imaging techniques. Eight patients, who presented >30 mg/day albuminuria, were submitted to percutaneous ultrasound guided renal biopsy. Kidney tissue fragments were examined under light, direct immunofluorescence and electron microscopy.
  
  
  RESULTS
  All patients showed mesangial enlargement. In five, mesangial hypercellularity was observed and four presented duplication of the glomerular basement membrane. Areas of glomerular sclerosis were diagnosed in four. Deposits of immunoglobulin M and C3 were present in six samples; deposits of IgG in four, IgA in three and C1q in two samples. In all patients, immunoglobulin A was reported in the lumen of renal tubules. Deposits of kappa and lambda were observed in six samples. Electron microscopy revealed dense deposits in the glomerular tissue of three patients. Arterial hypertension, small esophageal varices, slight increases in serum creatinine and decreases in serum albumin were associated with glomerular disease.
  
  
  CONCLUSIONS
  Renal disease associated with hepatosplenic schistosomiasis was verified in 12.7% of patients and type I membranoproliferative glomerulonephritis was observed in 50% of them. Schistosomal glomerulopathy still is an important problem in patients with hepatosplenic schistosomiasis in Brazil.
authors.affiliation: Infectology and Tropical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Brazil.
authors.forename: Valério Ladeira
authors.initials: VL
authors.lastname: Rodrigues
authors.forename: Alba
authors.initials: A
authors.lastname: Otoni
authors.forename: Izabela
authors.initials: I
authors.lastname: Voieta
authors.forename: Carlos Maurício de Figueiredo
authors.initials: CM
authors.lastname: Antunes
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Lambertucci
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008109:Liver Diseases, Parasitic / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012555:Schistosomiasis mansoni / Q000150:complications* / Q000175:diagnosis; D013158:Splenic Diseases / Q000150:complications* / Q000175:diagnosis / Q000469:parasitology