Risk Factors for Acute Kidney Injury in Visceral Leishmaniasis (Kala-Azar)

Michelle J. C. Oliveira Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Geraldo B. Silva Júnior Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Krasnalhia Lívia S. Abreu Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Natália A. Rocha Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Ana Valeska V. Garcia Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Luiz F. L. G. Franco Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Rosa M. S. Mota Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Alexandre B. Libório Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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Elizabeth F. Daher Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará; Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará; Department of Statistics, Science Center, Federal University of Ceará; Discipline of Nephrology, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

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The aim of this study was to investigate the factors associated with acute kidney injury (AKI) in patients with visceral leishmaniasis (VL). The study patients had a diagnosis of VL and were admitted to a tertiary hospital. A multivariate analysis was performed to analyze the risk factors for AKI. A total of 224 patients were included. The mean age was 36 ± 15 years. AKI was observed in 33.9% of cases. Risk factors associated with AKI were male gender (odds ratio [OR] = 2.2; P = 0.03), advanced age (OR = 1.05; P < 0.001), and jaundice (OR = 2.9; P = 0.002). There was an association between amphotericin B use and AKI (OR = 18.4; P < 0.0001), whereas glucantime use was associated with lower incidence of AKI compared with amphotericin B use (OR = 0.05; P < 0.0001). Mortality was 13.3%, and it was higher in AKI patients (30.2%). Therefore, factors associated with AKI were male gender, advanced age, and jaundice. Amphotericin B was an important cause of AKI in VL.

Author Notes

*Address correspondence to Elizabeth De Francesco Daher, Rua Vicente Linhares, 1198, CEP 60270-135, Fortaleza, Ceara, Brazil. E-mails: ef.daher@uol.com.br or geraldobezerrajr@yahoo.com.br

Authors' addresses: Michelle J. C. Oliveira and Elizabeth F. Daher, Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Rua Prof. Costa Mendes, 1608, 4 andar, CEP 60430-140, Ceará, Brazil, E-mails: mi_cavalcante@hotmail.com and ef.daher@uol.com.br. Geraldo B. Silva Júnior, Krasnalhia Lívia S. Abreu, Natália A. Rocha, Ana Valeska V. Garcia, Luiz F. L. G. Franco, and Elizabeth F. Daher, Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Rua Cap. Francisco Pedro, 1290, CEP 60430-370, Fortaleza, Ceará, Brazil, E-mails: geraldobezerrajr@yahoo.com.br, kras_livinha@yahoo.com.br, natalia.a.rocha@gmail.com, and liganefroufc@yahoogrupos.com.br. Rosa M. S. Mota, Department of Statistics, Science Center, Federal University of Ceará, Campus do Pici, bloco 910, CEP 60455-760, Fortaleza, Ceará, Brazil, E-mail: rosa@ufc.br. Alexandre B. Libório, Discipline of Nephrology, School of Medicine, University of Fortaleza, Rua Desembargador Floriano Benevides Magalhães, 221, 3 andar, CEP 60811-690, Fortaleza, Ceará, Brazil, E-mail: alexandreliborio@yahoo.com.br.

  • 1.

    Herwaldt BL, 1999. Leishmaniasis. Lancet 354: 11911199.

  • 2.

    Efstratiadis G, Boura E, Giamalis P, Mandala E, Leontsini M, Tsiaousis G, Memmos D, 2006. Renal involvement in a patient with visceral leishmaniasis. Nephrol Dial Transplant 21: 235236.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Guerin PJ, Olliaro P, Sundar S, Boelaert M, Croft SL, Desjeux P, Wasunna MK, Bryceson AD, 2002. Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda. Lancet Infect Dis 2: 494501.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Camargo LB, Langoni H, 2006. Impact of leishmaniasis on public health. Trop Dis 12: 527548.

  • 5.

    Dantas-Torres F, Brandão-Filho SP, 2006. Visceral leishmaniasis in Brazil: revisiting paradigms of epidemiology and control. Rev Inst Med Trop Sao Paulo 48: 151156.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Boakye DA, Wilson MD, Kweku M, 2005. A review of leishmaniasis in west Africa. Ghana Med J 39: 9497.

  • 7.

    Salgado Filho N, Ferreira TMAF, Costa JML, 2003. Involvement of the renal function in patients with visceral leishmaniasis (kala-azar). Rev Soc Bras Med Trop 36: 217221.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Oliveira AL, Brustoloni YM, Fernandes TD, Dorval ME, Cunha RV, Bóia MN, 2009. Severe adverse reactions to meglumine antimoniate in the treatment of visceral leishmaniasis: a report of 13 cases in the southwestern region of Brazil. Trop Doct 39: 180182.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Daher EF, Evangelista LF, Silva Júnior GB, Lima RS, Aragão EB, Arruda GA, Galeano NM, Mota RM, Oliveira RA, Silva SL, 2008. Clinical presentation and renal evaluation of human visceral leishmaniasis (kala-azar): a retrospective study of 57 patients in Brazil. Braz J Infect Dis 12: 329332.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Beltrame A, Arzese A, Camporese A, Rorato G, Crapis M, Tarabini-Castellani G, Boscutti G, Pizzolitto S, Calianno G, Matteelli A, Di Muccio T, Gramiccia M, Viale P, 2008. Acute renal failure due to visceral leishmaniasis by Leishmania infantum successfully treated with a single high dose of liposomal amphotericin B. J Travel Med 15: 358360.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Navarro M, Bonet J, Bonal J, Romero R, 2006. Secondary amyloidosis with irreversible acute renal failure caused by visceral leishmaniasis in a patient with AIDS. Nefrologia 26: 745746.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Rollino C, Bellis D, Beltrame G, Basolo B, Montemagno A, Bucolo S, Ferro M, Quattrocchio G, Coverlizza S, Quarello F, 2003. Acute renal failure in leishmaniasis. Nephrol Dial Transplant 18: 19501951.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ricci Z, Cruz D, Ronco C, 2008. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int 73: 538546.

  • 14.

    Lima Verde FA, Lima Verde IA, Silva Junior GB, Daher EF, Lima Verde EM, 2007. Evaluation of renal function in human visceral leishmaniasis (kala-azar): a prospective study of 50 patients from Brazil. J Nephrol 20: 430436.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Pisoni R, Wille KM, Tolwani AJ, 2008. The epidemiology of severe acute kidney injury. From BEST to PICARD, in acute kidney injury: new concepts. Nephron Clin Pract 109: c188c191.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Lima Verde FAA, Lima Verde FA, Daher EF, Santos GM, Sabóia Neto A, Lima Verde EM, 2009. Renal tubular dysfunction in human visceral leishmaniasis (kala-azar). Clin Nephrol 71: 492500.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Weisinger JR, Pinto A, Velasquez GA, Bronstein I, Dessene JJ, Duque JF, Montenegro J, Tapanes F, de Rousse AR, 1978. Clinical and histological kidney involvement in human kala-azar. Am J Trop Med Hyg 2: 357359.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Martinelli R, Lourenzo R, Rocha H, 1986. Absence of clinical abnormalities suggesting renal involvement during long-term course of visceral leishmaniasis. Rev Soc Bras Med Trop 19: 209212.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Tafuri WL, Michalik MSM, Dias M, Genaro O, Leite VHR, Barbosa AJA, Bambirra EA, Costa CA, Melo MN, Mayrink W, 1989. Estudo ao microscópio óptico e eletrônico do rim de cães natural e experimentalmente infectados com Leishmania chagasi. Rev Inst Med Trop Sao Paulo 31: 139145.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Prasad LS, Sen S, Ganguly SK, 1992. Renal involvement in kala-azar. Indian J Med Res 95: 4346.

  • 21.

    Polli A, Abramo F, Mancianti F, Nigro M, Pieri S, Bionda A, 1991. Renal involvement in canine leishmaniasis. A light microscopic, immunohistochemical and electron microscopic study. Nephron 57: 444452.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Dutra M, Martinelli M, Carvalho EM, Rodrigues LE, Brito E, Rocha H, 1985. Renal involvement in visceral leishmaniasis. Am J Kidney Dis 6: 2227.

  • 23.

    Duvic C, Nedelec G, Debord T, Herody M, Didelot F, 1999. Important parasitic nephropathies: update from the recent literature. Nephrologie 20: 6574.

  • 24.

    Chaigne V, Knefati Y, Lafarge R, Bronner J, McGregor B, Fouque D, Sabatier JC, 2004. A patient with visceral leishmaniasis and acute renal failure in necrotizing glomerulonephritis. Nephrologie 25: 179183.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Ben Salem L, Khiari K, Turki S, Cherif L, Ali IH, Maazoun I, Ben Moussa F, el Younsi F, Ben Abdallah N, Ben Maïz H, 2003. Obstructive acute renal failure revealing visceral leishmaniasis in a diabetic patient. Nephrologie 24: 9599.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Clevenberg P, Okome MN, Benoit S, Bendini JC, De Salvador F, Elbeze M, Cassuto E, Marty P, Dellamonica P, 2002. Acute renal failure as initial presentation of visceral leishmaniasis in an HIV-1 infected patient. Scand J Infect Dis 34: 546547.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Berdichevski RH, Luis LB, Crestana L, Manero RC, 2006. Amphotericin B-related nephrotoxicity in low-risk patients. Braz J Infect Dis 10: 9499.

  • 28.

    Bagnis CI, Deray G, 2002. Amphotericin B nephrotoxicity. Saudi J Kidney Dis Transpl 13: 481491.

  • 29.

    Olliaro PL, Guerin PJ, Gerstl S, Haaskjold AA, Rottingen JA, Sundar S, 2005. Treatment options for visceral leishmaniasis: a systematic review of clinical studies done in India, 1980–2004. Lancet Infect Dis 5: 763774.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Werneck GL, Batista MS, Gomes JR, Costa CH, 2003. Prognostic factors from visceral leishmaniasis in Teresina, Brazil. Infection 31: 174177.

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