Glomerulopathy associated with schistosomiasis mansoni

Abstract

Schistosomiasis is a parasitic disease directly related to poor sanitation. In Brazil, 42 million people live in areas where the disease is endemic, and it is still considered a serious public health problem. The kidney is one of the organs typically affected by this worm, with descriptions of renal tubular alterations, acute kidney injury and glomerular diseases. Among patients with active schistosomiasis, the incidence of glomerulopathy is 5–6% overall and 15% in those with the hepatosplenic form with the most commonly described histological patterns being membranoproliferative glomerulonephritis and focal segmental glomerulosclerosis. Although the pathogenesis of glomerular disease associated with schistosomiasis is uncertain, it is thought to involve immune complexes, especially in membranoproliferative glomerulonephritis, formed against a schistosome antigen and deposited in the glomeruli. The uncertain pathogenesis makes schistosomiasis treatment a challenge, as eradicating the parasite through the use of an anti-parasitic agent does not stop the progression to chronic kidney disease, raising questions about the need for immunosuppressive therapy. Thus, the aim of this review was to describe the so-called classic information on glomerular disease associated with schistosomiasis and to explore its probable pathogenic mechanisms in order to promote future discussion on the development of better treatment options.

Keywords:
Schistosomiasis; Glomerulonephritis, Membranoproliferative; Immunosuppresive Agents; Biomarkers; Antigens