Dengue virus infection can clinically manifest as dengue fever, dengue shock syn-drome and dengue hemorrhagic fever. Acute kidney injury as a result of dengue virus infection can occur due to various reasons including hypotension, rhabdomyolysis, sepsis and rarely immune complex mediated glomerular injury. However, glomerulonephritis associated with IgA Nephropathy in dengue virus infection has not been reported previously. We report a case of 15-year-old boy who was admitted with dengue fever and dialysis dependant acute kidney injury. Urine examination showed microscopic glomerular hematuria and proteinuria. Kidney biopsy showed mesangial proliferation with mesangial IgA dominant immune complex deposits and acute tubular necrosis. A repeated kidney biopsy 6 weeks after clinical recovery showed reversal of glomerular changes as well as resolution of mesangial IgA deposits.
"Similarly, rhabdomyolysis with1,5,7,19 and without AKI9,24,28 has been described in dengue patients. Renal histology results from patients with
dengue-associated AKI are scarce and to the best of our knowledge, there were no
previous cases of biopsy proven ATN with renal myoglobin deposition due to
rhabdomyolysis associated with DF31,37,39. "
[Show abstract][Hide abstract] ABSTRACT: Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.
Revista do Instituto de Medicina Tropical de São Paulo 04/2014; 56(1):85-88. DOI:10.1590/S0036-46652014000100014 · 1.01 Impact Factor
"As in some previous reports on IgA nephropathy associated with infection (9, 19), the glomerulopathy in our patient appeared to be transient. It is possible that removal of the causative organism from circulation and improvements in renal and hepatic dysfunction might result in increased clearance of immune-complexes, thus leading to the resolution of IgA nephropathy. "
[Show abstract][Hide abstract] ABSTRACT: Glomerulonephritis occurs as a rare form of renal manifestation in Plasmodium falciparum malaria. Herein, we report a case of falciparum malaria-associated IgA nephropathy for the first time. A 49-yr old male who had been to East Africa was diagnosed with Plasmodium falciparum malaria. Microhematuria and proteinuria along with acute kidney injury developed during the course of the disease. Kidney biopsy showed mesangial proliferation and IgA deposits with tubulointerstitial inflammation. Laboratory tests after recovery from malaria showed disappearance of urinary abnormalities and normalization of kidney function. Our findings suggest that malaria infection might be associated with IgA nephropathy.
Journal of Korean medical science 04/2012; 27(4):446-9. DOI:10.3346/jkms.2012.27.4.446 · 1.27 Impact Factor
"The importance of proteinuria resulting from dengue induced secondary glomerulonephritis is elucidated in literature by various authors . Renal biopsy in DHF, even showed the presence of IgA nephropathy that was transient in nature, showing the possibility of immune-complex disease in dengue fever because of DENV associated antigen-antibody-complex deposition in renal glomerular tissue . Identification of soluble immune complex in DHF specific for dengue virus in serum reiterates this issue . "
[Show abstract][Hide abstract] ABSTRACT: Worldwide there is a need to develop simple effective predictors that can distinguish whether a patient will progress from dengue fever (DF) to life threatening dengue hemorrhagic (DHF) or dengue shock syndrome (DSS). We explored whether proteinuria could be used as such a marker.
We included patients admitted to hospital with suspected dengue fever. Starting at enrollment until discharge, each patient's daily spot urine protein creatinine ratio (UPCR) was measured. We classified those with confirmed dengue infection as DF or DHF (including DSS) based on WHO criteria. Peak and day of onset of proteinuria was compared between both groups.
Compared to those with DF, patients with DHF had significantly higher median peak proteinuria levels (0.56 versus 0.08 g/day; p < 0.001). For patients with DHF, the median day of onset of proteinuria was at 6 days of defervescence, with a range of -2 to +3 days after defervescence. There were three patients with DF who did not have proteinuria during their illness; the five remaining patients with DF had a median day of onset of proteinuria of was at 6 days of defervescence with a range of 0 to +28 days.
Peak UPCR could potentially predict DHF in patients with dengue requiring close monitoring and treatment.
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