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Year : 1995  |  Volume : 61  |  Issue : 3  |  Page : 133-136

Renal functional status in leprosy

M Nadeem, BR Garg, AK Das 
 

Correspondence Address:
M Nadeem


Abstract

Renal functional impairment is known to occur in lepsory, specially of multibacillary type. Pedal oedema was seen in 30% patients. Urine analysis showed proteinurea in 3.33%. epithelial casts in 13.33% and microscopic haematuria in 6.66%. A raised 24 hours urinary protein excretion was seen in 53.33%, 60% had a low 24 hours creatinine clearance rate. Abnormal serum creatinine was found in 16.66%, raised serum urea values were seen in 6.66% cases



How to cite this article:
Nadeem M, Garg B R, Das A K. Renal functional status in leprosy.Indian J Dermatol Venereol Leprol 1995;61:133-136


How to cite this URL:
Nadeem M, Garg B R, Das A K. Renal functional status in leprosy. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2020 Feb 19 ];61:133-136
Available from: http://www.ijdvl.com/text.asp?1995/61/3/133/4178


Full Text

 Introduction



Mycobacterium leprae ordinarily does not invade the renal parenchyma, but considerable renal functional impairment in leprosy has been reported.[1][2][3][4] The impairment has been alleged to be due to circulating immune complexes which are associated with type 2 lepra reactions.[2] A variety of structural lesions like, interstitial nephritis, glomerulonephritis, secondary amyloidosis, pyelonephritis, distal tubular functional defects and renal lepromas[5] have been reported. All these may end up with renal failure which is perhaps the commonest cause of death in leprosy patients.

 Materials and Methods



Patients with leprosy attending the Dermatology and STD out-patients department of JIPMER Hospital were taken for this study. The period of study extended from April 1992 to July 1993.

The criteria for patient selection were as follows:

1. Paucibacillary leprosy patients with type 1 reaction.

2. Multibacillary leprosy patients with or without type 1 and 2 reaction.

3. Burnt out lepromatous leprosy patients.

A detailed history was noted. After proper examination the patients were placed in the appropriate spectrum of the disease as defined by Ridley and Jopling.

A general examination was done to rule out any pallor, cyanosis and pedal oedema. The pulse rate and blood pressure were specially checked to rule out hypertension.

In all cases blood sugar estimation was done to rule out diabetes mellitus. In addition serum urea, creatinine, protein and electrolyte estimation was also done. Serum cholesterol estimation was done to rule out nephrotic syndrome. Urine sugar, protein, microscopic examination for sediments, casts and specific gravity estimation were done in all cases. Specific tests done for kidney function included:

1. 24 hours urinary protein excretion, and

2. 24 hours creatinine clearance

 Results



Thirty patients (28 males and 2 females) were included in the study. Their age varied from 22 to 77 years and most of the patients (60%) were between 31-50 years. The type of leprosy patients were affected with is shown in [Figure:1]. Seventeen of the 30 patients (56.66%) were on treatment and of these 8 were on dapsone monotherapy. While the rest were on MDT. 13 patients were untreated. Seventeen patients (56.66%) were in reaction [Table:1] and 9 patients (30%) had pitting pedal oedema [Table:2].

Various urinary abnormalities were observed. Urinalysis revealed proteinurea (3.33%), epithelial casts (13.33%), microscopic haematuria (6.66%). Five patients (16.66%) had abnormal serum creatinine [Table:3] and 2 patients (6.66%) had abnormal serum urea levels. 16 patients (53.33%) had 24 hours urinary protein excretion of more than 150 mg [Table:4]. 18 patients (60%) had a low 24 hours creatinine clearance rate [Figure:2]. Serum cholesterol, electrolytes and urine specific gravity were normal in all patients.

 Discussion



Impairment of renal function seen in leprosy is due to the circulating immune complexes which are frequently associated with type 2 reaction. The other factors implicated are increased susceptibility to bacterial infections as a result of immunosuppression seen in multibacillary leprosy.[6]

Proteinuria is a commonly detected abnormality in renal disease. We were able to find proteinuria in only 1 (3.33%) patient, whereas Kanwar et al[7] have found a high incidence of proteinuria in their patients. Other workers have also found a high incidence of proteinuria.[1, 8] Some have though failed to demonstrate proteinuria.[4] The low incidence of proteinuria seems to be related to the pattern of disease in the patients.

Haematuria is another commonly observed findings seen in upto 100% patients having type 2 reaction and 13% of the uncomplicated lepromatous patients.[1],[7],[8] We found haematuria in only 2 patients (1BL, 1LL). Mittal et al however could not find haematuria in any of their patients.[9]

Casts of different types have been described specially in reactional states. We observed casts of epithelial type in 4 patients (3LL and 1BL) all with type 2 reaction. Others have reported granular casts most often, though hyaline and red blood cell casts have also been reported.[1],[7], [10] Some have failed to find casts in the urine of their patients.[11]

Biochemical alterations are often encountered in renal disorders. Amongst leprosy patients, some workers have found raised levels of serum urea in upto 53% patients.[5],[7] Some have failed to find significant rise in serum urea levels even in reactional states.[1],[8],[9] We found abnormal serum urea levels in 2 patients (6.66%) in our study. Abnormalities in serum creatinine were observed in 5 patients (16.66%). Our findings were similar to that of some workers who found it to be raised specially in reactional states.[1],[12] Glomerular filtration rate is another parameter to determine the renal functional status. It normally corresponds to the 24 hours creatinine clearance. In our study 18 (60%) patients had a low creatinine clearance rate indicating a low glomerular filtration rate. Similar findings have been reported by others.[2],[3]

We also had 3 patients with a high creatinine clearance rate. Such findings have been reported to occur in patients having early glomerulonephritis.[12] Our patients with a high creatinine clearance rate did have such changes.

Thus in our study the urinary abormalities were similar to those found by earlier workers. If multibacillary leprosy patients of long standing duration are followed with such renal parameters, a large number of patients in incipient renal failure can be detected.

 Aknowledgement



I am grateful to Dr Rajeev Sharma, consultant Dermatologist, Bishen Skin Center, for his guidance in preparing this manuscript.

References

1Bajaj AK, Gupta SL, Sinha SN, et al. Renal functional status in lepromatous leprosy. Int J Lepr 1981;49:37-41.
2Drutz DJ, Gutman RA. Renal manifestations of leprosy, glomerulonephritis a complication of ENL. Am J Trop Med Hyg 1973;22:496-502.
3Gokhale BB, Kurkure NB. Phenol red excretion test of kidney function in leprosy patients. Ind J Med Sci 1958;12:331-3.
4Gautam RA, Lu WH, Drutz DJ. Renal manifestations of leprosy impaired acidification and concentration of urine in patients with leprosy. Am J Trop Med Hyg 1973;22:223-8.
5Sainani GS, Rao KVM. Renal changes in leprosy. J Asso Physicians India 1974;22:659-64.
6Brycesson ADM. Immunology of leprosy, Lepr Rev 1976;47:235-44.
7Kanwar AJ, Baharija SC, Belhaj MS. Renal function status in leprosy. Ind J lepr 1984;56:595-9.
8Thomas G, Karat ABA, Rao PSS, et al. Changes in renal function during reactive phases of lepromatous leprosy. Int J lepr 1970;38:170-6.
9Mittal MM, Agarwal SC. Maheshwari HB, et al. Renal lesions in leprosy. Arch Pathol 1972,93:8-12.
10Shuttleworth JS, Ross SH. Secondary amyloidosis in leprosy. Ann Int Med 1956;45:23-38.
11Reddy CRRM, Sulochona G, Naidu PS, et al. Amyloidosis in leprosy. Med Surg 1970;10:45-6.
12Date A, Thomas A, Mathai R, et al. Glomerular pathology in leprosy, an electron microscopic study. Am J Trop Med Hyg 1977;26:266-72.

 

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