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Envolvimento renal na salmonelose septicêmica prolongada

In a study of 68 cases of prolonged salmonella bacteremia (patientes with hepatosplenic schistosomiasis mansoni and bacteremia due to a Salmonella sp), 28 of them (41,2%j showed proteinúria and alterations of the urinary sediment (hematuria, leucocyturia and casts). Three of these patientes presented with a nephrotic syndrome and 4 of them had high blood urea leveis. Kidney histology was obtained in nine cases, showing membrano-proliferative glomerulonephritis in 5, a focal glomerular sclerosis in 2, in some a mesangio-proliferative glomerulonephritis and, in one, minimal histologic changes. Urinary tract infection due to Salmonella organisms (the same isolated from blood) was observed in 3 cases. The ocorrurence of a similar histologic pattern of glomerular pathology in cases of prolonged septicemic salmonellosis when compared to just hepatosplenic schistosomiasis with glomerulonephritis suggested that S. mansoni infection was probahly the major determinant of the glomerular pathology. However, the high rate of urinary tract im/olvement and the disappearence of some of the alterations following effective therapy of the Salmonella bacteremia suggests an additional role of the bacterial agent as a determinant of the glomerular pathology. Also, the kidney intersticial mononuclear infiltration, more conspicuous and intense in cases of septicemic salmonellosis accompanied by bacteriuria, also suggested an immuno logical damage to the kidneys probably mediated by the salmonella infection.

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