title: It is time to review concepts on renal involvement in leprosy: pre- and post-treatment evaluation of 189 patients.
abstract: BACKGROUND
  Functional and morphological renal lesions have been widely described in leprosy for decades. Nevertheless few studies have assessed renal function pre- and during treatment after the advent of multidrug therapy (MDT).
  
  
  METHODS
  This is a prospective study involving 189 consecutive patients, with all forms of leprosy (Ridley-Jopling scale). Laboratory (serum urea and creatinine, estimated GFR, urinalysis, microalbuminuria, urinary RBP) and clinical features of renal disease were evaluated previously and after onset (3 and 8 months later) of MDT.
  
  
  RESULTS
  One hundred and eighty-nine patients (M 1.8: F 1; mean age 44 ± 16 years) were included just after diagnosis of leprosy and before the introduction of MDT. Mean time until manifestation of symptoms and/or signs of leprosy was 29 ± 56 months (25 days-480 months). Microhematuria and microalbuminuria were detected in 7.5% and 9.6% of the cases, respectively. Elevated serum creatinine was detected in 34% pre-MDT; this was statistically more frequent in males, hypertensive and frequent users of non-steroidal anti-inflammatory drugs (NSAID), as well as in patients with erythema nodosum lepromatosum, 45.5% by the time of diagnosis, 18% after 3 months and 9% after 8 months of MDT (p = 0.039).
  
  
  CONCLUSIONS
  Our results suggest that functional renal lesions in leprosy are currently mild and predominantly of glomerular origin, in opposition to the severe involvement described in the past. This improved outcome of renal disease secondary to leprosy is possibly due to the advent of MDT and effective treatment of episodes of reaction, leading to shorter periods of active infectious disease.
authors.affiliation: a Glomerulopathy Section, Division of Nephrology, Federal University of Sao Paulo (UNIFESP) , Sao Paulo , Brazil.
authors.forename: Maria Goretti
authors.initials: MG
authors.lastname: Polito
authors.affiliation: a Glomerulopathy Section, Division of Nephrology, Federal University of Sao Paulo (UNIFESP) , Sao Paulo , Brazil.
authors.forename: Sílvia R
authors.initials: SR
authors.lastname: Moreira
authors.affiliation: a Glomerulopathy Section, Division of Nephrology, Federal University of Sao Paulo (UNIFESP) , Sao Paulo , Brazil.
authors.forename: Sonia K
authors.initials: SK
authors.lastname: Nishida
authors.affiliation: a Glomerulopathy Section, Division of Nephrology, Federal University of Sao Paulo (UNIFESP) , Sao Paulo , Brazil.
authors.forename: Gianna
authors.initials: G
authors.lastname: Mastroianni Kirsztajn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002648:Child; D003404:Creatinine / Q000097:blood*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000097:blood*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood*; D007918:Leprosy / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000472:pathogenicity*; D011446:Prospective Studies; D016896:Treatment Outcome; D016482:Urinalysis; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: Chronic renal failure; Mycobacterium leprae; chronic kidney disease; glomerulonephritis; renal abnormalities