Heat, Humidity, and Hematuria: Glomerular Complications of Tropical Infections.

Abstract

Background: Tropical regions, home to nearly 40% of the world's population, face a high burden of infectious diseases due to climate, socioeconomic factors, and limited healthcare access. Many tropical infections - including malaria, dengue, leptospirosis, schistosomiasis, filariasis, scrub typhus, and human immunodeficiency virus (HIV) - have been increasingly recognized as causes of glomerular disease. These infections can directly or indirectly affect the kidney, resulting in a diverse spectrum of glomerular pathologies.

Summary: This review highlights the epidemiology, clinical manifestations, pathophysiology, and renal histopathological findings associated with major tropical infections that involve the glomeruli. It describes how parasitic, bacterial, and viral pathogens trigger immune-mediated glomerular injury, contribute to acute kidney injury, or lead to chronic kidney disease. Specific glomerular lesions, including mesangioproliferative glomerulonephritis (GN), membranoproliferative GN, focal segmental glomerulosclerosis, and HIV-associated nephropathy, are detailed with mechanistic insights. The article also discusses diagnostic challenges; therapeutic approaches, including antiparasitic and antiretroviral therapy; and the role of preventive strategies such as vaccination, vector control, and mass drug administration.

Key message: Tropical infections are increasingly recognized as important yet underappreciated contributors to glomerular disease, particularly in low-resource settings. Early recognition and timely targeted treatment of infection-related GN can significantly reduce the risk of long-term kidney damage. To effectively mitigate the kidney disease burden, comprehensive public health measures - including enhanced surveillance, vaccination initiatives, and integrated vector control strategies - are essential.