title: Renal function in hepatosplenic schistosomiasis--an assessment of renal tubular disorders.
abstract: BACKGROUND
  Renal involvement in Schistosoma mansoni infection is not well studied. The aim of this study is to investigate the occurrence of renal abnormalities in patients with hepatosplenic schistosomiasis (HSS), especially renal tubular disorders.
  
  
  METHODS
  This is a cross-sectional study with 20 consecutive patients with HSS followed in a medical center in Maceió, Alagoas, Brazil. Urinary acidification and concentration tests were performed using calcium chloride (CaCl2) after a 12-h period of water and food deprivation. The biomarker monocyte chemoattractant protein 1 (MCP-1) was quantified in urine. Fractional excretion of sodium (FENa+), transtubular potassium gradient (TTKG) and solute-free water reabsorption (TcH2O) were calculated. The HSS group was compared to a group of 17 healthy volunteers.
  
  
  RESULTS
  Patients' mean age and gender were similar to controls. Urinary acidification deficit was found in 45% of HSS patients. Urinary osmolality was significantly lower in HSS patients (588 ± 112 vs. 764 ± 165 mOsm/kg, p = 0,001) after a 12-h period of water deprivation. TcH2O was lower in HSS patients (0.72 ± 0.5 vs. 1.1 ± 0.3, p = 0.04). Urinary concentration deficit was found in 85% of HSS patients. The values of MCP-1 were higher in HSS group than in control group (122 ± 134 vs. 40 ± 28 pg/mg-Cr, p = 0.01) and positively correlated with the values of microalbuminuria and proteinuria.
  
  
  CONCLUSIONS
  HSS is associated with important kidney dysfunction. The main abnormalities found were urinary concentrating ability and incomplete distal acidification defect, demonstrating the occurrence of tubular dysfunction. There was also an increase in urinary MCP-1, which appears to be a more sensitive marker of renal damage than urinary albumin excretion rate.
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil; Department of Internal Medicine, Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Daniella Bezerra
authors.initials: DB
authors.lastname: Duarte
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil.
authors.forename: Lucas Alexandre
authors.initials: LA
authors.lastname: Vanderlei
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil.
authors.forename: Raianne Kívia de Azevêdo
authors.initials: RK
authors.lastname: Bispo
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil.
authors.forename: Maria Eliete
authors.initials: ME
authors.lastname: Pinheiro
authors.affiliation: School of Medicine, Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, CE, Brazil.
authors.forename: Geraldo Bezerra
authors.initials: GB
authors.lastname: da Silva
authors.affiliation: Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Alice Maria Costa
authors.initials: AM
authors.lastname: Martins
authors.affiliation: Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Gdayllon Cavalcante
authors.initials: GC
authors.lastname: Meneses
authors.affiliation: Department of Internal Medicine, Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Elizabeth De Francesco
authors.initials: Ede F
authors.lastname: Daher
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications; D018932:Chemokine CCL2 / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D009994:Osmolar Concentration; D011507:Proteinuria / Q000150:complications; D012552:Schistosomiasis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D012720:Severity of Illness Index; D016482:Urinalysis
chemical_list: D018932:Chemokine CCL2