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Renal diseases in the tropics 

Renal diseases in the tropics

Chapter:
Renal diseases in the tropics
Author(s):

Vivekanand Jha

DOI:
10.1093/med/9780199204854.003.2111_update_002

August 28, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Description of acute kidney injury in scrub typhus.

Expanded coverage of plant nephrotoxins.

Updated on 27 Feb 2014. The previous version of this content can be found here.
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date: 24 March 2017

Kidney diseases encountered in tropical areas are a mix of conditions that have worldwide distribution and those that are secondary to factors unique to the tropics, e.g. climatic conditions, infectious agents, nephrotoxic plants, envenomations, and chemical toxins. Important presentations are with nephrotic syndrome, acute kidney injury (AKI), and progressive renal insufficiency. In addition to the climate, cultural factors, illiteracy, superstitions, living conditions, level of access to health care, and nutritional status also affect the nature and course of disease. Knowledge of such conditions and issues is important for medical professionals in all parts of the globe, as ease of travel means that individuals and practices are exported with increasing frequency.

Glomerular diseases—important infection-related glomerulopathies include quartan malarial nephropathy in African children; schistosomal nephropathy in North Africa and South America; postinfectious glomerulonephritides in South America, Africa, and Asia; and filarial nephropathy in South-East Asia and Africa. An immunological basis secondary to prolonged exposure to microbial antigens is thought to be responsible. Once established, the course of disease is rarely modified by treatment of underlying infection, but the incidence of these conditions has shown a decline in some areas alongside the control of infection.

Acute kidney injury—diarrhoeal diseases, obstetric complications, intravascular haemolysis due to inherited red-cell enzyme deficiency, copper sulphate poisoning, ingestion of toxic plants, snake bites, insect stings, and infections specific to the particular region are the main causes of community-acquired AKI in the tropics. Renal failure is often part of multiorgan failure, which significantly increases the risk of death. Falciparum malaria and leptospirosis are the most important infectious aetiologies.

Toxins—use of traditional medicines that include indigenous herbs and chemicals dispensed by faith healers are the most important toxic causes of AKI in sub-Saharan Africa. Bites by venomous snakes belonging to viper and sea snake families, and stings by bees, hornets, and wasps, cause renal failure through a combination of direct nephrotoxicity, intravascular haemolysis, and rhabdomyolysis. Prompt antivenom administration and supportive treatment is the key to recovery from snake envenomation. Renal failure is irreversible in the few patients with obstetric complications and snake-bite who develop acute renal cortical necrosis.

Uncommon presentations of tropical kidney diseases include renal infarction (with AKI in case of bilateral involvement) due to mucormycosis, chyluria due to filariasis, amyloidosis due to tuberculosis and leprosy, obstructive nephropathy due to lower urinary tract schistosomiasis, and progressive interstitial nephritis secondary to chronic ingestion of some tropical herbs.

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