La lepra y el riñón

Abstract

Renal lesions in leprosy occur in pauci- or multi-bacillary patients but predominate in those with multi-bacillary lesions and especially in those with type 2 reactions or erythema nodosum leprosum. Renal affection is usually silent, chronic and can become the cause of death in leprosy patients due to uraemia. It is easily detected, through simple urinalysic in which (albuminuria) proteinuria, cylindruria and haematuria are detected. This urinalysis should be done on each leprosy patient and must be done during type 2 reactions, in which some degree of compromise of the kidney (mainly by immune-complexes) has been dernonstrated in 100% of reactions, along with cutaneous, lymphadenopatic, neuritic and occular lesions. Renal lesions in Colombian leprosy patients have not been properly studied, probably because cutaneous lesions cal1 physicians\u27 main attention. Systemic secondary amyloidosis and immune complex membranoproliferative glornerulonephritis have been documented.A review is made of leprosy\u27s effect on the kidneys when related to secondary phenomena, such as precipitation within glomerules of antigen-antibody complexes, or fibrillar proteins resulting from chronic inflamation orto complications dueto polychemotherapy against the leprosy bacillus, ¡.e. not being due to M. Ieprae presence within the renal nerves or parenchyma. The following circumstances have been described: a) defects in urine concentration and acidification; b) acute and chronic interstitial nephritis; c) acute renal failure; d) systemic secondary or reactive amyloidosis; and e) glomerulonephritis. It is also pointed out that leprosy is not a contraindication for renal transplant, because the disease (having already been cured) may not become active again, or, if it does, or erupts because of the irnmunosuppression needed to maintain the transplant, can be controlled with availble polychemotherpy