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Kidney complications of parasitic diseases

Nature Reviews Nephrology volume 18, pages 396–406 (2022)Cite this article

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Abstract

Parasitic agents have been known to cause human disease since ancient times and are endemic in tropical and subtropical regions. Complications of parasitic diseases, including kidney involvement, are associated with worse outcomes. Chagas disease, filariasis, leishmaniasis, malaria and schistosomiasis are important parasitic diseases that can damage the kidney. These diseases affect millions of people worldwide, primarily in Africa, Asia and Latin America, and kidney involvement is associated with increased mortality. The most common kidney complications of parasitic diseases are acute kidney injury, glomerulonephritis and tubular dysfunction. The mechanisms that underlie parasitic disease-associated kidney injury include direct parasite damage; immunological phenomena, including immune complex deposition and inflammation; and systemic manifestations such as haemolysis, haemorrhage and rhabdomyolysis. In addition, use of nephrotoxic drugs to treat parasitic infections is associated with acute kidney injury. Early diagnosis of kidney involvement and adequate management is crucial to prevent progression of kidney disease and optimize patient recovery.

Key points

  • Parasitic diseases are a major public health problem worldwide and are associated with multiple complications, including kidney injury.

  • The highest incidence of parasitic diseases is in tropical regions; however, they are increasingly observed in high-income countries, mainly among immigrant populations.

  • Kidney involvement is common in Chagas disease, filariasis, leishmaniasis, malaria and schistosomiasis.

  • Kidney injury in these diseases is mediated by immunological phenomena, systemic manifestations of the parasitic infection, direct damage caused by the parasites and use of nephrotoxic medications.

  • Acute kidney injury, glomerulonephritis and tubular dysfunction are the most frequently observed kidney abnormalities in patients with parasitic diseases.

  • Early detection of kidney impairment in these patients is essential to enable adequate management and prevent progression to chronic kidney disease and/or kidney failure.

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Fig. 1: Kidney involvement in Chagas disease.
Fig. 2: Kidney involvement in filariasis.
Fig. 3: Kidney involvement in visceral leishmaniasis.
Fig. 4: Kidney involvement in malaria.
Fig. 5: Kidney involvement in schistosomiasis.

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Acknowledgements

The authors thank all health care workers who dedicate their careers to the treatment of infectious and parasitic diseases, especially those in Brazil, Egypt, India and Thailand. E.F.D. and G.B.S.J. have received grants from the Brazilian Research Council — Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq (protocol numbers 302017/2018-6 and 310974/2020-8).

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Authors and Affiliations

  1. School of Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil

    Elizabeth De Francesco Daher & Geraldo Bezerra da Silva Junior

  2. School of Medicine, University of Fortaleza, Fortaleza, Ceara, Brazil

    Geraldo Bezerra da Silva Junior

  3. Department of Nephrology, Lokmanya Tilak Government Medical College and Hospital, Mumbai, India

    Mayuri Trivedi

  4. Faculty of Medicine, Cairo University, Cairo, Egypt

    Tarek Fayad

  5. Division of Nephrology, Chulalongkorn University, Bangkok, Thailand

    Nattachai Srisawat

  6. Department of Nephrology, Saveetha Medical College and Hospital, Thandalam, Chennai, India

    Sanjeev Nair

  7. Vector Biology and Vector Borne Disease Research Unit, Chulalongkorn University, Bangkok, Thailand

    Padet Siriyasatien

  8. Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Amazonas State University, Manaus, Amazonas, Brazil

    Marcus Vinícius Guimarães de Lacerda

  9. São José do Rio Preto Medical School. São José do Rio Preto, São Paulo, Brazil

    Maria Alice Sperto Ferreira Baptista

  10. Manipal Hospitals, Bangalore, India

    Mahesha Vankalakunti

  11. The George Institute for Global Health India, New Delhi, India

    Vivekanand Jha

  12. Faculty of Medicine, Imperial College London, London, UK

    Vivekanand Jha

  13. University of New South Wales, Sydney, Australia

    Vivekanand Jha

Authors
  1. Elizabeth De Francesco Daher
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  2. Geraldo Bezerra da Silva Junior
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  3. Mayuri Trivedi
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  4. Tarek Fayad
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  5. Nattachai Srisawat
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  6. Sanjeev Nair
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  7. Padet Siriyasatien
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  8. Marcus Vinícius Guimarães de Lacerda
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  9. Maria Alice Sperto Ferreira Baptista
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  10. Mahesha Vankalakunti
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  11. Vivekanand Jha
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Contributions

E.D.F.D., G.B.S.J., M.T., N.S., P.S., S.N., T.F., M.A.S.F.B., M.V. and V.J. researched the data for the article. E.D.F.D., G.B.S.J., M.T., N.S., P.S., S.N. and T.F. wrote the text. E.D.F.D., G.B.S.J., M.V.G.L., T.F., M.A.S.F.B. and M.V. made substantial contributions to discussion of the content. All authors reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Elizabeth De Francesco Daher.

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The authors declare no competing interests.

Peer review

Peer review information

Nature Reviews Nephrology thanks A. Bagga, who co-reviewed with V. Mahesh; R. Claure-Del Granado; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary information

Glossary

Anthropozoonosis

A disease that is transmitted from animals to humans.

Haematophagous

Feeding on blood.

‘Mega’ organs

Highly disproportionate enlargement of organs, which is typically seen in Chagas disease.

Dyskinesias

Movement disorders characterized by involuntary muscle movements.

Amastigote

Rounded cells of protozoa without flagella, especially used to describe Leishmania spp.

Chyluria

The presence of chyle (lymph laden with fat) in the urine, resulting in a milky white colour.

Dysuria

Pain or discomfort during urination.

Haematochyluria

The presence of blood and chyle or lymph in the urine.

Oliguria

Reduced urine output, usually defined as <500 ml in 24 h.

Rhabdomyolysis

A clinical condition caused by muscle injury with release of intracellular content, including myoglobin, creatine kinase, lactate dehydrogenase and electrolytes. These substances are harmful to the kidney.

Hyperparasitaemia

A high parasite load in the bloodstream.

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Daher, E.D.F., da Silva Junior, G.B., Trivedi, M. et al. Kidney complications of parasitic diseases. Nat Rev Nephrol 18, 396–406 (2022). https://doi.org/10.1038/s41581-022-00558-z

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