Visceral leishmaniasis due to Leishmania infantumwith renal involvement in HIV-infected patients

Matteo Vassallo, Olivier Moranne, Damien Ambrosetti, Pierre-Yves Jeandel, Christelle Pomares, Elisabeth Cassuto, Annick Boscagli, Guillaume Giraud, Nathalie Montagne, Chiara Dentone, Ilaria Demacina, Barbara Villaggio, Giovanni Secondo, Giuseppe Ferrea, Corinne Passeron, Laurence Saudes, Regis Kaphan, Pierre Marty, Eric Rosenthal

BackgroundWe describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings.Cases presentationFour HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete recovery of renal function after anti-parasitic treatment. Main clinical presentations were nephrotic or nephritic syndrome and/or acute renal failure secondary to membranoproliferative type III glomerulonephritis or acute interstitial nephritis. Clinical outcome was poor, probably as a consequence of insufficient immuno-virological control of the HIV infection.ConclusionsOur findings suggest that the main histological findings in case of renal involvement due to Leishmania infantum infection in HIV-infected patients are type III MPGN and acute interstitial nephritis, with a histological specificity similar to that observed in canine leishmaniasis. Poor immune status in HIV-infected patients, altering the capacity for parasite clearance, and prolonged course of chronic active VL in this population may lead to the development of specific renal lesions.