一名孕妇感染恶性疟原虫后肾脏受累。

IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES
Octavio René García-Flores, Mayra Eugenia Avilés-Ramírez, Sabrina Vianey Castillo-Paniagua, Edgar Misael Pérez-Jiménez, José Carlos Gasca-Aldama, María Virgilia Soto-Abraham, Juan Carlos Bravata-Alcántara, Juan Manuel Bello-López, Giorgina Barbara Piccoli, Enzo Vásquez-Jiménez
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引用次数: 0

摘要

背景:人们对孕妇严重疟疾感染后的肾功能变化和预后知之甚少。患有 AKI 的孕妇肾脏替代治疗的适应症与普通人群相似。这是一例严重恶性疟原虫感染导致脑疟疾和急性肾损伤(AKI)的孕妇患者,她在住院期间需要进行肾替代治疗和肾活检:一名来自赤道几内亚的 29 岁孕妇因溶血性贫血、高胆红素血症和血小板减少症入院。住院期间进行了血液浓涂片检查,观察到恶性疟原虫寄生虫血症,并通过实时 PCR 检测进行了确诊。患者继发缺血性脑血管事件、低血压和严重的脑疟疾。确诊为恶性疟原虫感染后,患者开始服用青蒿琥酯、蒿甲醚/本芴醇和伯氨喹。肾活检显示,患者患有活动性肾小管间质性肾炎,伴有急性肾小管病变和色素性肾小管病变,免疫荧光呈阴性。CVVHDF 后,患者接受了间歇性血液透析,直至肾功能恢复。出院后,进行了随访,直到剖宫产成功结束妊娠,且未发现肾功能或蛋白尿恶化:结论:在这个病例中,开始进行强化透析,当肾功能改善后,透析强度逐渐降低。由于肾功能的变化,患者接受了肾活检,结果显示肾小管间质性肾炎是感染的一种表现形式。肾活检有助于区分肾小管和肾小球受累,而胎盘生物标记物(sslt1-PlGF)则有助于排除子痫前期和胎盘损伤。妊娠期 AKI 的多学科治疗方法应成为一项规则,在妊娠期间应努力关注母婴健康,并在分娩后监测肾功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Kidney involvement in Plasmodium falciparum infection in a pregnant patient.

Background: The course of kidney function and outcomes of severe malaria infection in pregnant women is poorly understood. The indications for renal replacement therapy in pregnant patients with AKI are similar to the general population. This is the case of a pregnant patient with severe Plasmodium falciparum infection that caused cerebral malaria, acute kidney injury (AKI) who required renal replacement therapy and kidney biopsy during her hospitalization.

Case presentation: A 29-year-old pregnant woman from Equatorial Guinea was admitted to the hospital with haemolytic anaemia, hyperbilirubinaemia and thrombocytopenia. During hospitalization, a thick blood smear was performed where parasitaemia by P. falciparum were observed and confirmed by real-time PCR assay. The patient developed cerebral malaria secondary to an ischaemic-type cerebral vascular event, hypotension and severe. After confirming diagnosis of P. falciparum infection, artesunate, artemether/lumefantrine and primaquine were started. Kidney biopsy revealed an active tubulointerstitial nephritis with acute tubular lesion and pigment tubulopathy with negative immunofluorescence. After CVVHDF, the patient received intermittent haemodialysis until the recovery of kidney function. After discharge, follow-up was carried until the successful resolution of the pregnancy by cesarean delivery and not shown deterioration in kidney function or proteinuria.

Conclusion: In this case, intensive dialysis was started and dialysis intensity progressively reduced when kidney function improved. Due to the evolution of kidney function, a kidney biopsy was performed which showed tubulointerstitial nephritis as a manifestation of the infection. While the kidney biopsy was of interest for discriminating between tubular and glomerular involvement, the availability of placental biomarkers (sflt1-PlGF) would have been of help for ruling out preeclampsia and placental damage. The multidisciplinary approach to AKI during pregnancy should be the rule, with diligent care of maternal-fetal well-being during pregnancy and monitoring of kidney function after delivery.

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来源期刊
Malaria Journal
Malaria Journal 医学-寄生虫学
CiteScore
5.10
自引率
23.30%
发文量
334
审稿时长
2-4 weeks
期刊介绍: Malaria Journal is aimed at the scientific community interested in malaria in its broadest sense. It is the only journal that publishes exclusively articles on malaria and, as such, it aims to bring together knowledge from the different specialities involved in this very broad discipline, from the bench to the bedside and to the field.
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