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MCQs in Tropical Medicine

Rob Skelly DTM+H FRCP

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Answer 6

Nephrotic syndrome is a recognised complication of infection with

True a. Schistosoma mansoni
True b. Plasmodium malariae
True c. Hepatitis B virus
True d. Mycobacterium leprae
True e. Loa loa

Nephrotic syndrome is many times more common in the tropics than in the UK. The incidence of nephritogenic infections is higher.
Malnutrition makes proteinuria clinically manifest at an earlier stage.

Table 6

Causes of nephrotic snydrome in the tropics
*Beta-heamolytic streptococci
*Lupus nephritis
*Plasmodium malariae
*Schistosoma mansoni
* Leprosy
Multiple myeloma
Filarial worms
Renal vein thrombosis
Hepatitis B
Minimal change glomerulonephritis

(*= numerically important)

Schistosomal nephrotic syndrome
This occurs in about 0.5% of patients with S.mansoni infection. It is usually confined to those patients with large numbers of worms and hepatosplenic disease.
Histology: membranoproliferative
Pathogenesis: immune complex deposition
Treatment: prednisolone, cyclophosphamide

Plasmodium malariae
The peak incidence is in the 5-8yrs age range. Progression to end-stage renal failure within 3-5yrs is usual. Spontaneous remissions are rare. Microscopic haematuria may occur. The proteinuria is highly selective in 20% of patients. Parasites are present in the blood in 75% of cases early in the disease.
Histology: capillary wall thickening
Pathogenesis: immune complex deposition
Treatment: 50% of those with highly selective proteinuria respond to steroids

Hepatitis B glomerulopathy
In children active liver disease is absent. In adults it is usually present. 80% of those affected by the glomerulopathy are male.
Histology: membranous glomerulonephritis
Prognosis: spontaneous remission is usual.

Filarial glomerulopathy
Bancroftian filariasis, onchocerciasis and loiasis can all cause nephrotic syndrome. This does not respond to therapy. They each may alternatively cause acute nephritis. This is a relatively rare complication.

Secondary amyloidosis is more common in lepromatous patients, especially those having frequent episodes of erythema nodosum leprosum.


Copyright: Rob Skelly 2006