PDF(Pubmed)
Abstract：
Microfilarial parasites can obstruct the lymphatic tree giving rise to varying lymphatic and extra-lymphatic symptoms. Renal manifestations can range from asymptomatic proteinuria, chyluria, and nephrotic syndrome, to acute glomerulonephritis. The diagnosis of filariasis is usually made by the demonstration of the parasite in the peripheral blood smear, with or without eosinophilia. The renal involvement by this parasite has been sparsely reported in the literature. We hereby report five cases of filariasis detected on histopathological examination of renal biopsies, performed for other indications, along with a brief report of the additional histological findings. Three native and two graft biopsies were included. All our patients were male, with a mean age of 47 years (range 37 to 66 years). The serum creatinine ranged from 1.2 to 12.9 mg/dL. The mean 24-hour urinary protein was 3.6 gm/day. Peripheral blood eosinophilia was not recorded in any case, however, ESR was raised in all cases. Urine examination revealed varying proteinuria, with hematuria in two cases. Histological examination revealed microfilaria in all five biopsies, along with focal segmental glomerulosclerosis in two cases, combined cellular and humoral rejection, minimal change disease and acute tubular necrosis in one case each respectively. All patients were treated with diethylcarbamazine 6mg/kg/day or 12 days, in addition to the renal medications. Diagnosing the parasite is crucial as the patient is likely to benefit due to the timely treatment of the disease. Reporting this case series highlights an interesting finding in nephropathology.
摘要：
微丝寄生虫会阻塞淋巴树，从而引起不同的淋巴和淋巴外症状。肾脏表现可以从无症状的蛋白尿，乳糜尿,和肾病综合征，急性肾小球肾炎。丝虫病的诊断通常是通过在外周血涂片中显示寄生虫来进行的，有或没有嗜酸性粒细胞增多症。在文献中很少报道这种寄生虫的肾脏受累。我们在此报告5例丝虫病在肾活检的组织病理学检查中发现，为其他适应症而进行的，以及其他组织学发现的简短报告。包括三个天然和两个移植物活检。我们所有的病人都是男性,平均年龄为47岁（范围为37至66岁）。血清肌酐范围为1.2至12.9mg/dL。平均24小时尿蛋白为3.6gm/天。在任何情况下都没有记录到外周血嗜酸性粒细胞增多,然而,在所有情况下都提高了ESR。尿液检查显示不同的蛋白尿，有血尿2例。组织学检查显示在所有五个活检中都有微丝菌，伴有两例局灶性节段性肾小球硬化，细胞和体液联合排斥反应，微小病变和急性肾小管坏死各1例。所有患者均接受二乙基卡巴嗪6mg/kg/天或12天治疗，除了肾脏药物。诊断寄生虫至关重要，因为患者可能会因为疾病的及时治疗而受益。报告此病例系列突出了肾病学中的一个有趣发现。
