Eosinophilic glomerulonephritis in children in Southwestern Uganda

• Published in: Kidney international Vol. 71; no. 6; pp. 569 - 573
• Main Authors: Walker, A., Ellis, J., Irama, M., Senkungu, J., Nansera, D., Axton, J., Coward, R.J., Peat, D.S., Bode, H.H., Mathieson, P.W.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2007; Nature Publishing; Elsevier Limited
• Subjects: Adolescent; Africa; Biological and medical sciences; Biopsy; Child; Child, Preschool; childhood; Eosinophilia - diagnosis; Eosinophilia - epidemiology; Eosinophilia - pathology; Eosinophils - pathology; Female; Glomerulonephritis; Glomerulonephritis - diagnosis; Glomerulonephritis - epidemiology; Glomerulonephritis - pathology; HIV; Human immunodeficiency virus; Humans; Kidney Glomerulus - pathology; malaria; Male; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Plasmodium falciparum; Plasmodium malariae; Prevalence; Prospective Studies; proteinuria; Uganda - epidemiology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Uganda; Africa; childhood; HIV; malaria; proteinuria; Africa; Human; Kidney disease; Glomerulonephritis; Immunopathology; Protozoal disease; Nephrology; Urinary system disease; Malaria; Retroviridae; AIDS; Parasitosis; Immune deficiency; Lentivirus; Eosinophil; Urology; Infection; Virus; Viral disease; Human immunodeficiency virus; Child; Proteinuria
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5002085

Acute renal disease is common in sub-Saharan Africa, with high mortality. Its etiology is poorly understood; quartan malaria owing to Plasmodium malariae was implicated in previous series. Few previous studies have included histological data; furthermore, much of the literature pre-dates the human immunodeficiency virus (HIV) epidemic. We report prospective analysis of acute proteinuric renal disease in children in rural Uganda. Clinical and laboratory data are presented on 65 patients (aged 2–14 years, mean 8.4; 35 male, 30 female) in 41 of whom histological diagnosis was obtained by renal biopsy. The most frequent histological finding was endocapillary proliferative glomerulonephritis (GN) in 27/41 cases, in 20 of which eosinophils were very prominent. No cases showed features of HIV nephropathy. Malarial films were positive in 11 cases: all owing to Plasmodium falciparum. Patients were treated with diuretics, antihypertensives, and supportive measures. Corticosteroids were rarely used, being reserved for patients with minimal changes on renal biopsy. Clinical outcomes were fair: 91% of patients survived to discharge. We conclude that acute GN is common in children in Uganda, that an unusual eosinophilic proliferative GN is the most frequent histological finding, that HIV is not implicated as an important factor in this age group, and that good outcomes can be achieved using simple clinical and laboratory diagnostic methods. Renal biopsy in selected cases is feasible and helpful, especially in allowing rational use of corticosteroids and other potentially toxic treatments. Symptomatic treatments and careful supportive care will allow the majority of children to recover.