Clinical and Histological Kidney Involvement in Human Kala-Azar

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  • Departments of Medicine and Pathology, Cátedra de Clínica y Terapéutica Médica “A,” Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela

A 19-yr-old woman developed prolonged fever, weight loss, hepatosplenomegaly, anemia, leukopenia, and hyperglobulinemia. Appropriate tests indicated that she had visceral leishmaniasis (kala-azar). Urinalysis demonstrated significant proteinuria and microhematuria with the presence of red cell casts. A kidney biopsy was performed. Light microscopy showed a slight mesangial thickening and segmental mesangial proliferation. Immunofluorescence demonstrated deposits of immunoglobulins A and M, complement, and fibrinogen. Electron microscopy showed subendothelial and intramembranous deposits. After treatment with N-methylglucamine antimonate the proteinuria and microhematuria disappeared and the patient recovered uneventfully.