Leprosy nephropathy

Abstract

Leprosy is mainly characterized by integumentary and peripheral nervous system lesions, and renal involvement in this disease was first described in autopsy findings in the beginning of the twentieth century. Renal lesions are found in all forms of leprosy, being more frequent in the multibacillary form. The kidneys are the most affected organs in secondary amyloidosis that develops in leprosy. The exact mechanism leading to the development of leprosy-associated glomerulopathy is not completely understood. Mycobacterium leprae does not seem to be directly involved, although it has been found in some patients’ glomeruli. Reduction of glomerular filtration rate (GFR) has been observed in some series in approximately 50% of cases. Patients with the multibacillary form had significantly lower GFR and urinary concentration capacity than those with the paucibacillary forms. Urinary acidification deficit is found in 1/3 of paucibacillary and multibacillary cases. Reduced urinary concentration capacity is found in more than 2/3 of cases. Acute kidney injury (AKI) has been associated with leprosy glomerulonephritis and acute tubular necrosis secondary to other phenomena, such as ischemic injury or nephrotoxicity caused by drugs used in the treatment, such as rifampin and nonsteroidal anti-inflammatory drugs. Treatment includes specific chemotherapy, suppression of reaction outbreaks, prevention of physical disabilities, physical, and psychosocial rehabilitation and seems to improve leprosy nephropathy.