- Email: [email protected]
Terminal hematuria
nephrology image
http://www.kidney-international.org & 2015 International Society of Nephrology
Kidney International (2015) 88, 204; doi:10.1038/ki.2014.318
Terminal hematuria Vikyath Prakash1, Daniel Caplivski2 and Joseph A. Vassalotti1 1
Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA and 2Division of Infectious Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA Correspondence: Vikyath Prakash, Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, New York 10029, USA. E-mail: [email protected]
Figure 1 | Light microscopy Schistosoma haematobium ova, 40 magnification.
Figure 2 | Light microscopy Schistosoma haematobium ova, 80 magnification.
A 19-year-old man was referred to a nephrology clinic for microscopic hematuria evaluation. This Senegalese immigrant noted intermittent, painless, terminal hematuria for the last 3 years. There was no other past medical history or medication, and his physical exam was normal. Laboratory examinations were remarkable for white blood cell count 9103/ml with 27% eosinophils. Serum creatinine and estimated glomerular filtration rate were 85 mmol/l and 107 ml/min per 1.73 m2, respectively. The urine protein:Cr ratio was 0.59 mg/mg. Urine microscopy showed 425 RBC/ HPF and Schistosoma haematobium ova with the characteristic terminal spine (Figures 1 and 2). The patient was treated with praziquantel 40 mg/kg in two divided doses with undetectable urinary ova on repeat microscopy. Post therapy the eggs can continue to shed in the urine for 2 weeks and eosinophilia can persist for up to 12 weeks. S. haematobium can be found in North Africa, sub-Saharan Africa, the Middle East, Turkey, and India. Worldwide, 1 in
30 individuals have Schistosoma infection that is acquired during childhood and peaks in prevalence and intensity at ages 15–20 years. Left untreated the infection can lead to fibrosis and calcification of the bladder and ureters, resulting in obstructive nephropathy. Chronic infection is associated with an increased risk of squamous cell carcinoma of the bladder and has also been associated with glomerulonephritis. A renal biopsy is indicated with proteinuria 41 g/day. The African Association of Nephrology has classified the disease into five categories based on histopathology. All infections, even asymptomatic, should be treated, as early therapy can prevent the sequelae of chronic disease. This presentation illustrates that, although schistosomiaisis is not endemic to the United States, with an increasing immigrant population and a substantial worldwide prevalence the nephrologist should maintain a high index of suspicion to diagnose, treat, and prevent the significant morbidity associated with S. haematobium infection.
204
Kidney International (2015) 88, 204
http://www.kidney-international.org & 2015 International Society of Nephrology
Kidney International (2015) 88, 204; doi:10.1038/ki.2014.318
Terminal hematuria Vikyath Prakash1, Daniel Caplivski2 and Joseph A. Vassalotti1 1
Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA and 2Division of Infectious Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA Correspondence: Vikyath Prakash, Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, New York 10029, USA. E-mail: [email protected]
Figure 1 | Light microscopy Schistosoma haematobium ova, 40 magnification.
Figure 2 | Light microscopy Schistosoma haematobium ova, 80 magnification.
A 19-year-old man was referred to a nephrology clinic for microscopic hematuria evaluation. This Senegalese immigrant noted intermittent, painless, terminal hematuria for the last 3 years. There was no other past medical history or medication, and his physical exam was normal. Laboratory examinations were remarkable for white blood cell count 9103/ml with 27% eosinophils. Serum creatinine and estimated glomerular filtration rate were 85 mmol/l and 107 ml/min per 1.73 m2, respectively. The urine protein:Cr ratio was 0.59 mg/mg. Urine microscopy showed 425 RBC/ HPF and Schistosoma haematobium ova with the characteristic terminal spine (Figures 1 and 2). The patient was treated with praziquantel 40 mg/kg in two divided doses with undetectable urinary ova on repeat microscopy. Post therapy the eggs can continue to shed in the urine for 2 weeks and eosinophilia can persist for up to 12 weeks. S. haematobium can be found in North Africa, sub-Saharan Africa, the Middle East, Turkey, and India. Worldwide, 1 in
30 individuals have Schistosoma infection that is acquired during childhood and peaks in prevalence and intensity at ages 15–20 years. Left untreated the infection can lead to fibrosis and calcification of the bladder and ureters, resulting in obstructive nephropathy. Chronic infection is associated with an increased risk of squamous cell carcinoma of the bladder and has also been associated with glomerulonephritis. A renal biopsy is indicated with proteinuria 41 g/day. The African Association of Nephrology has classified the disease into five categories based on histopathology. All infections, even asymptomatic, should be treated, as early therapy can prevent the sequelae of chronic disease. This presentation illustrates that, although schistosomiaisis is not endemic to the United States, with an increasing immigrant population and a substantial worldwide prevalence the nephrologist should maintain a high index of suspicion to diagnose, treat, and prevent the significant morbidity associated with S. haematobium infection.
204
Kidney International (2015) 88, 204