Tropical nephrology Flashcards
What is important about the mean age of AKI in developed vs developing countries?
Developing countries - 37.1yo
Developed countries - 72yo
What factors in developing countries predispose to AKI?
Malnutrition
Hypovolemia with high ambient temperatures (sweating)
Higher G6PD deficiency rate
What is the most common cause of AKI in children?
HUS - diarrhoea disease
What is the most important infectious cause of haematuria and ARF?
VHF-like syndromes
How is Dengue fever diagnosed?
- Acute fever (+/- biphasic)
- Hemorrhagic tendencies
- Thrombocytopenia
- Evidence of plasma leakage
Which viruses belong to the arenaviridae family?
Lassa
Lujo
Argentine
Bolivian
Brazilian
Venezuelan
Which viruses belong to the bunyaviridae family?
Hantavirus
CCHF (nairovirus)
Garissa (orthobunyavirus)
RVF (phlebovirus)
Which viruses belong to the filoviridae family?
Ebola
Marburg
Which viruses belong to the flaviviridae family?
Dengue
Yellow fever
Omsk hemorrhagic fever
Kyasanur Forest disease
What are the 2 viruses in the tick borne encephalitis group that cause VHF?
Omsk hemorrhagic fever virus
Kyasanur Forest disease virus
Which VHFs often don’t result in VHF syndrome?
Dengue
RVF
Lassa
What is VHF syndrome?
Capillary leak
Bleeding diathesis
Hemodynamic compromise -> shock
Which VHFs can be treated with IV ribavirin?
Lassa
RVF
CCHF
HFRS (hantavirus)
In which VHF-like syndromes is the majority of AKI non-oliguric?
Ebola
Marburg
Dengue
Yellow fever
Lassa
CCHF
Which viruses causes hemorrhagic fever with renal syndrome?
Hantavirus
What are the principle bacterial infectious causing renal complications?
Salmonella
Shigella
Leptospirosis
Meliodosis
Cholera
Tetanus
Scrub typhus
Diphtheria
Which are the principle mycobacterial infections causing renal complications?
Tuberculosis
Leprosy
Usually subacute or chronic disease course
What are the hemodynamic factors involved in the pathogenesis of renal complications in tropical disease?
Prolonged febrile illness (sweating, rhabdomyolysis, catecholamines, hyperpyrexia)
GI fluid losses (severe diarrhoea)
Peripheral pooling (endotoxemia, malaria)
What are the majority of acute interstitial nephritis in tropical disease caused by?
Drugs (40%)
Infection itself <10%
Which infections cause acute interstitial nephritis?
Typhoid
Meliodosis
Leptospirosis
Dengue
Hantavirus
Leishmaniasis
Tuberculosis
Which glomerular syndrome is caused by scabies?
PIGN
Which glomerular syndrome is caused by leprosy?
NS
Amyloid
Which glomerular syndrome is caused by filariasis?
NS
IC
Which glomerular syndrome is caused by falciparum malaria?
RPGN
Which glomerular syndrome is caused by streptococcus?
PIGN
Which glomerular syndrome is caused by non-falciparum malaria?
NS
Which glomerular syndrome is caused by HAV?
MPGN
Which glomerular syndrome is caused by salmonella?
IC (assoc with schistosomiasis and giardiasis)
Which parasites result in immune mediated interstitial nephritis?
L. Donovan (visceral leishmaniasis, kala azar, treated with ample B)
Falciparum malaria
Vivax malaria
Which bacteria result in immune mediated endothelial injury?
E.coli 0157 and others
Shigella toxin
Strep suis
Discuss salmonella infection with regard to renal dysfunction
Pyelonephritis
ATN
Glomerulonephritis
Febrile phase with hematuria and proteinuria
Mild with full recovery within 2w of treatment
Post-infectious GN
Discuss shigella infection with regard to renal dysfunction
ATN (dehydration)
Proliferative GN
HUS w/ cortical necrosis and diffuse fibrous deposits
Discuss cholera infection with regard to renal dysfunction
ARF due to fluid and electrolyte loss
Severe hypokalemia -> proximal tubular vacuolation
Cortical necrosis
Discuss tetanus infection with regard to renal dysfunction
Rhabdomyolysis
ANS overactivity
Mild
Non-oliguric
Discuss leptospirosis with regard to renal dysfunction
Several serotypes, contact w/ rodent urine
Biphasic
1. Septicaemia (conjunctivitis)
2. Meningitis, cholestatic jaundice, ARDS, ARF
ARF in almost all cases but usually mild, non-oliguric
What are the features of Weil’s disease and which organism causes it?
Leptospirosis
Hepatic necrosis
Coaugulopathy
What renal pathology is seen in leptospirosis?
Necrotizing vasculitis
Mild MPGN
Interstitial nephritis
What renal pathology is seen in dengue fever?
ATN (interstitial edema, mononuclear cell infiltration)
MPGN
What is the vector of HFRS?
Rodents
Discuss the clinical presentation of sangassou virus
Transient thrombocytopenia
Conjunctival haemorrhages
Palatine petechiae
Truncal petechial rash
Oliguria
Azotemia
Proteinuria
Haematuria
After 3d, rash disappear and patient develops polyuria
Which fungal toxin is often associated with the pathogenesis of Balkan nephropathy?
Ochratoxin
Progressive interstitial nephropathy
Is AKI more common in patients with malaria from endemic or non-endemic areas?
Non-endemic (non-immune)
What is the pathogenesis of falciparum AKI?
Hypovolemia
NO and cytokine mediated vasodilation
Resistance to vasoactive hormones
Cytopathic hypoxia
Mechanical obstruction by infected RBCs
Why is peritoneal dialysis efficacy reduced in falciparum malaria AKI?
Obstruction of peritoneal microcirculation with infected erythrocytes
What is the most common schistosomiasis species in Africa?
Haematobium
Which schistosomiasis species causes immune complexes?
Mansoni
Leads to 5 classes of GN
- mesangioproliferative
- exudative
- mesangiocapillary
- FSGS
- amyloidosis
What is the “liver effect”
Interplay between portal hypertension and glomerular disease
Kipper cells remove circulating immune complexes and schistosome antigens BUT as liver disease worsens, more immune complexes and antigens reach the glomeruli
What are the 2 major forms of renal disease in TB?
Direct infection of urinary tract
Secondary amyloidosis
How does tuberculous interstitial nephritis appear on histology?
Chronic tubulointerstitial nephritis
Caseating granulomas
What are the clinical manifestations of renal disease in TB?
Insidious
Dysuria
Macroscopic haematuria
Renal colic
Constitutional symptoms
Urethral strictures
Calcifications
What is the gold standard for diagnosing renal disease in TB?
3-6 first morning MSU
Which glomerular syndrome is associated with rifampicin?
Tubular injury
Interstitial injury
Crescenteric GN (rare)
What is the sequelae of tubular dysfunction with drug induced nephrotoxicity?
Glucosuria
Hyperuricosuria
Polyuria
Increased urinary excretion of polyclonal light chains
What is the cause of renal pathology in snake bites?
Usually rhabdomyolysis
Toxicity
DIC
What are the clinical features of raw carp bile toxicity?
GI upset
Hepatitis
ATN
What are the majority of South African toxic ARF cases caused by?
Cape aloe
Callilepsis laureola (“impila”
What renal pathology is seen in mushroom poisoning?
Severe ATN
What renal pathology is seen in Djenkol bean?
Crystal nephropathy
Urolithiasis
What renal pathology is seen in impila?
ATN
Hepatocellular injury
Protracted hypoglycaemia
What renal pathology is seen in semecarpus anavardium?
Acute cortical necrosis
What renal pathology is seen in paraquat toxicity?
ATN
Hepatic and pulmonary manifestations
What renal pathology is seen in copper sulphate toxicity?
ATN
Acute hepatocellular failure
