Relação entre marcadores tradicionais de função renal e a proteína Monócitos-1 (MCP-1) urinária em pacientes com hanseníase

Abstract

Introduction: Leprosy patients can present with kidney disease from glomerular (glomerulonephritis, amyloidosis) or tubule-intertitial etiology. Aims: To evaluate renal abnormalities in leprosy patients through traditional markers of renal disease and Monocyte Chemotactic Protein-1 (MCP-1). Methods: This is a cross-sectional study of 44 patients with clinical and laboratory diagnosis of leprosy and with no previous anti-mycobacterium treatment and reaction episode. Patients were recruited in public health centres in Fortaleza, Ceara, Brazil between August 2012 and August 2013. The protocol of this study was approved by the Ethical Comitee of the Walter Cantidio University Hospital, Federal University of Ceara, Brazil (Nº 267.426). Also, a group of 15 healthy subjects were included as a control group. Glomerular filtration rate (GFR), protein excretion, microalbuminuria and Urinary oxidative stress (malondialdehyde-MDA) were estimated. Urinary MCP-1 was determined by sandwich enzyme-linked immunosorbent assay. All urine measurements were normalized by urinary creatinine concentration. Results: Age and gender were similar between leprosy patients and control groups. Patients’ average age was 36±10 years, and 61% were male. Time from symptoms to leprosy diagnosis varied from one month to 8 years, with a median time of 17 months. Twenty-six patients had skin smear-positive test (59,1%) and 18 were negative (40,1%). Clinically, there were 14 (31,8%) tuberculoid polar form (TT/BT), 19 (43,2%) boderline (BB) and 11 (25%) lepromatous polar form (LL/BL). Regarding renal function, no patient had chronic kidney disease. Leprosy patients had a higher urine protein excretion (97,6±69,2 vs 6,5±4,3 mg/g-Cr, p<0,001), urinary MDA (1,77±1,31 vs 1,27±0,66 mmol/g-Cr, p=0,0372) and urinary MCP-1 (101±79,8 vs 34,5±14,9 mg/g-Cr, p=0,006) than healthy controls. Urinary MCP-1 was higher in multibacillary than in paucibacillary patients (122,1±91,9 vs 72±46,1 mg/g-Cr, p=0,023). There was a positive correlation between urinary MCP-1 and bacteriological index in skin smear (r=0,104; p=0,035), urinary MCP-1 and albumin excretion rate (r=0,171; p=0,006) and urinary MCP1 and urinary MDA (r=0,205; p=0,002). Conclusion: Leprosy patients with no clinical kidney disease have increased urinary MCP-1 and its levels are even higher according patients approximates to lepromatous polar form. Moreover, urinary MCP-1 was associated with urinary oxidative stress and urine albumin excretion, suggesting these patients are at increased risk of developing clinical kidney disease in the future.