title: Human kidney damage in fatal dengue hemorrhagic fever results of glomeruli injury mainly induced by IL17.
abstract: Acute kidney injury is an unusual complication during dengue infection. The objective of this study was to better identify the characteristics of glomerular changes focusing on in situ immune cells and cytokines. An immunohistochemical assay was performed on 20 kidney specimens from fatal human cases of dengue hemorrhagic fever (DHF). It was observed a lymphomononuclear infiltrate, neutrophils and nuclear fragmentation in the glomeruli, hydropic degeneration, nuclear retraction, eosinophilic tubules and intense acute congestion. Sickle erythrocytes were frequent in glomeruli and inflammatory infiltrate. The glomeruli presented endothelial swelling and mesangial proliferation. Lymphocytes CD4+ predominated over CD8+ T cells, B cells and natural killer cells. There were also an expressive number of macrophagic CD68+ cells. S100, Foxp3 and CD123 cells were not identified. Cells expressing IL17 and IL18+ cytokines predominated in the renal tissues, while IL4, IL6, IL10, IL13, TNF-alpha and IFN-gamma were rarely visualized. The high number of cells expressing IL17 and IL18+ could reflect the acute inflammatory response and possibly contribute to the local lesion. CD8+ T cells could play a role in the cytotoxic response. DHF is a multifactorial disease of capillary leakage associated with a "Tsunami of cytokines expression". The large numbers of cells expressing IL17 seems to play a role favoring the increased permeability.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Lab. da Disciplina de Patologia de Moléstias Transmissíveis, Departamento de Patologia, São Paulo, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual, SP, Brazil.
authors.forename: Carla
authors.initials: C
authors.lastname: Pagliari
authors.affiliation: Universidade do Estado do Pará, Belém, Pará, Brazil; Núcleo de Medicina Tropical, UFPA, Belém, Pará, Brazil.
authors.forename: Juarez Antônio
authors.initials: JA
authors.lastname: Simões Quaresma
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Lab. da Disciplina de Patologia de Moléstias Transmissíveis, Departamento de Patologia, São Paulo, Brazil.
authors.forename: Luciane
authors.initials: L
authors.lastname: Kanashiro-Galo
authors.affiliation: Hospital Guilherme Álvaro, Seção de Anatomia Patológica, Santos, SP, Brazil.
authors.forename: Leda Viegas
authors.initials: LV
authors.lastname: de Carvalho
authors.affiliation: Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual, SP, Brazil.
authors.forename: Webster Oliveira
authors.initials: WO
authors.lastname: Vitoria
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Lab. da Disciplina de Patologia de Moléstias Transmissíveis, Departamento de Patologia, São Paulo, Brazil.
authors.forename: Wellington Luiz Ferreira
authors.initials: WL
authors.lastname: da Silva
authors.affiliation: Hospital Guilherme Álvaro, Seção de Anatomia Patológica, Santos, SP, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Penny
authors.affiliation: Universidade do Estado do Pará, Belém, Pará, Brazil; Instituto Evandro Chagas, Ananindeua, Pará, Brazil.
authors.forename: Barbara Cristina Baldez
authors.initials: BC
authors.lastname: Vasconcelos
authors.affiliation: Universidade do Estado do Pará, Belém, Pará, Brazil; Instituto Evandro Chagas, Ananindeua, Pará, Brazil. Electronic address: pedrovasconcelos@iec.pa.gov.br.
authors.forename: Pedro Fernando
authors.initials: PF
authors.lastname: da Costa Vasconcelos
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Lab. da Disciplina de Patologia de Moléstias Transmissíveis, Departamento de Patologia, São Paulo, Brazil.
authors.forename: Maria Irma Seixas
authors.initials: MI
authors.lastname: Duarte
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D001402:B-Lymphocytes / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D016207:Cytokines / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D020381:Interleukin-17 / Q000276:immunology*; D007673:Kidney Cortex Necrosis / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D007694:Killer Cells, Natural / Q000276:immunology; D019595:Severe Dengue / Q000150:complications* / Q000276:immunology / Q000503:physiopathology
chemical_list: D016207:Cytokines; D020381:Interleukin-17
keywords: Cells; Cytokines; Dengue; Immunohistochemistry; Kidney