RESUMO
BACKGROUND: The aim of this study was to compare clinical manifestations, laboratory data, morbidity and mortality between adults and children with visceral leishmaniasis, with a focus on kidney function. METHODS: This was a retrospective cohort study with 432 patients with visceral leishmaniasis diagnosed at 1 center in the northeast of Brazil. Patients were divided into 2 groups according to age (>21 years and ≤ 21 years old). RESULTS: The time between onset of symptoms and beginning of treatment was longer in adults (89.5 versus 48.5 days, P < 0.001); signs and symptoms were similar in both groups. Failure of treatment with glucantime was more common in adults (17.6% versus 8.8%, P = 0.008). Acute kidney injury was observed in 160 patients (37.0%), and it was more severe in adults. Risk factors for acute kidney injury in adults were hypokalemia, leukopenia, chills and amphotericin B use. In children, secondary infections were found to increase the risk for acute kidney injury. Overall mortality was 8.8%, and it was significantly higher in adults (12.6% versus 4.1%, P = 0.002). CONCLUSIONS: The adult population had more severe laboratory abnormalities and a worse prognosis, possibly due to delay in diagnosis. Acute kidney injury is prevalent in both groups, and it is usually more severe in adults.
Assuntos
Leishmaniose Visceral/epidemiologia , Injúria Renal Aguda/parasitologia , Adolescente , Adulto , Idoso , Antiprotozoários/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/mortalidade , Leishmaniose Visceral/fisiopatologia , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
BACKGROUND: There is no comprehensive study about renal function in children with visceral leishmaniasis (VL). The aim of this study was to investigate the incidence of acute kidney injury (AKI) in children with VL using pRIFLE classification and to determine the risk factors for AKI. METHODS: A retrospective cohort study was conducted with 146 patients younger than 14 years of age with VL diagnosis in one center located at the northeast of Brazil from December 2003 to 2010. AKI was evaluated by pediatric Risk, Injury, Failure, Loss, End-stage kidney disease (pRIFLE) criteria. RESULTS: The mean age was 5 ± 4.0 years (range, 5 months to 14 years), and 53.4% were males. AKI was observed in 67 patients (45.9%). The distribution according to the pRIFLE criteria was as follows: risk 45 (67.2%), injury 21 (31.3%), and failure 1 (1.5%). Patients in the AKI group were significantly younger (P < 0.001) and had jaundice (P = 0.028) and secondary infections (P = 0.001) more often than non-AKI patients. The AKI group had a significantly lower serum sodium (P = 0.03), potassium (P = 0.009), serum albumin (P = 0.001), and elevated serum globulins (P = 0.04), and a more prolonged prothrombin time (P = 0.001) at admission. Independent risk factors for AKI were: secondary infections (OR: 3.65, 95% CI: 1.426-9.358, P = 0.007), serum albumin decrement (OR: 1.672, 95% CI: 1.065-2.114, P = 0.019 per each 1 mg dL(-1) serum albumin decrement), and high serum globulin (OR: 1.35, 95% CI: 1.031-1.779, P = 0.029 per each 1 mg dL(-1) serum globulin increment). CONCLUSIONS: AKI is a frequent complication in children with VL. The risk factors for AKI were secondary infections, high serum globulin and low serum albumin.
Assuntos
Injúria Renal Aguda/epidemiologia , Leishmaniose Visceral/complicações , Leishmaniose Visceral/epidemiologia , Injúria Renal Aguda/fisiopatologia , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hospitalização , Humanos , Incidência , Lactente , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Testes de Função Renal , Masculino , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise , Soroglobulinas/análiseRESUMO
There are few studies regarding the clinical presentation of visceral leishmaniasis (VL) in children. The aim of this study was to investigate the clinical manifestations, major complications and causes of death in children with VL. A retrospective study was performed with pediatric patients (< or = 14 years old) with a diagnosis of VL in Fortaleza, state of Ceara, in Northeast Brazil. A total of 120 patients were included. The mean age was 5 +/- 3.9 years, and 53.4% were male. The main clinical manifestations at admission were: fever (94.2%), splenomegaly (94.2%), hepatomegaly (82.5%), anorexia (55%), malaise (47.5%), cough (41.6%), abdominal pain (27.5%), vomiting (25.5%), and diarrhea (16.6%). Acute kidney injury was found in 25% of the patients. The main complication during hospital stay was pulmonary infection, found in 27.5% (n = 33), leading to sepsis in 3 cases. Glucantime was the drug of choice in 90% (n = 108) of the cases, amphotericin B in 7.5% (n = 9) and AmBisome in 2.5% (n = 3). Death occurred in 4 cases (3.3%) due to sepsis (3 cases) and hemorrhagic complications (1 case). Visceral leishmaniasis is a frequent infection among children in our region. The main complications were pulmonary infection and acute kidney injury related to antiparasitic therapy, along with sepsis and hemorrhage.
Assuntos
Leishmaniose Visceral/complicações , Saúde da População Urbana , Adolescente , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Leishmaniose Visceral/mortalidade , Leishmaniose Visceral/terapia , MasculinoRESUMO
BACKGROUND: The aim of this study is to investigate tubular and glomerular function after visceral leishmaniasis (VL) treatment with pentavalent antimonials. METHODS: This is a prospective study including 14 patients with VL diagnosis treated with pentavalent antimonials. Urine acidification and concentration tests were performed. Estimated glomerular filtration rate (eGFR), fractional excretion of sodium (FE(Na)) and potassium (FE(K)) and free water clearance (C(H2O)) were measured to assess glomerular and tubular function. RESULTS: The VL group had a significantly lower FE(K), serum sodium and plasma osmolality (P(osm)). No significant differences were found regarding proteinuria, eGFR, FE(Na) or C(H2O). Patients in the VL group had lower urinary osmolality (U(osm)) before DDAVP use when compared to the control group, as well as a lower U/P(osm). The urinary pH before and after CaCl(2) load was higher in the VL group. CONCLUSION: This study shows evidence of reversal of some tubular dysfunction in VL, but other dysfunctions may persist, especially urinary acidification capacity.
Assuntos
Rim/metabolismo , Rim/fisiologia , Leishmaniose Visceral/metabolismo , Leishmaniose Visceral/terapia , Adolescente , Adulto , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Humanos , Concentração de Íons de Hidrogênio , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Potássio/metabolismo , Estudos Prospectivos , Sódio/química , Sódio/metabolismoRESUMO
The aim of this study was to investigate the factors associated with acute kidney injury (AKI) in patients with visceral leishmaniasis (VL). The study patients had a diagnosis of VL and were admitted to a tertiary hospital. A multivariate analysis was performed to analyze the risk factors for AKI. A total of 224 patients were included. The mean age was 36 +/- 15 years. AKI was observed in 33.9% of cases. Risk factors associated with AKI were male gender (odds ratio [OR] = 2.2; P = 0.03), advanced age (OR = 1.05; P < 0.001), and jaundice (OR = 2.9; P = 0.002). There was an association between amphotericin B use and AKI (OR = 18.4; P < 0.0001), whereas glucantime use was associated with lower incidence of AKI compared with amphotericin B use (OR = 0.05; P < 0.0001). Mortality was 13.3%, and it was higher in AKI patients (30.2%). Therefore, factors associated with AKI were male gender, advanced age, and jaundice. Amphotericin B was an important cause of AKI in VL.