Avaliação renal em indivíduos infectados por Schistosoma mansoni em uma área de alta endemicidade no Nordeste brasileiro

Abstract

Schistosomiasis affects approximately 240 million people worldwide. In Brazil, it is estimated that 1.5 million people are infected with Schistosoma mansoni and up to 15% of diagnosed individuals develop kidney damage. Renal involvement in schistosomiasis mansoni is characterized by glomerular lesions, with a high incidence, especially in chronically infected patients living in areas of high endemicity. Renal damage occurs slowly and is often asymptomatic, with a long-term manifestation of chronic kidney disease, with progressive loss of kidney functions, and early detection of subclinical kidney disease is of great importance. The aim of this study was to investigate renal alterations in patients infected with S. mansoni through non-traditional urinary biomarkers of kidney injury and their association with the different parasite loads found. The cross-sectional study was carried out in the village of Siebra, rural area of the municipality of Maruim, state of Sergipe, Brazil. Two groups were formed based on the Kato-Katz method and the IgG-ELISA-SEA: positive group (GP) and negative group (GN) for schistosomiasis. Urinary creatinine, albuminuria were quantified by immunoturbidimetry and proteinuria by the colorimetric method. The urinary biomarkers of podocytic lesion (VEGF and Nephrine) and glomerular inflammation (MCP-1) were measured by immunoassay and expressed by the urinary creatinine ratio. Urinary VEGF showed significantly high urinary levels GP compared to NG (p = 0.004) and at different intensities of infection it showed high levels in low parasitic load (p = 0.020). MCP-1 and nephrin did not show significant differences between groups. Infected patients did not have clinically evident kidney disease, with dosages of classic markers of renal function within normal excretion ranges, however, increased signs of glomerular damage were observed, evidenced by the significant increase in urinary VEGF levels, including in individuals with low parasite load of S. mansoni. This finding suggests that VEGF may be a promising early biomarker of kidney damage in schistosomiasis, however, further studies are needed to assess VEGF and to better understand the pathophysiological mechanisms of kidney damage caused by S. mansoni.