Review article: immune nephritides due to malaria.

Abstract

A nine-year-old boy from a non-malarial endemic area of Nyanza, Kenya, neighbouring a holoendemic area of the province was admitted to hospital in 1981 with abdominal distension, leg swelling and swelling of the scrotum of 7 days duration. On examination he was found to have nephrotic syndrome with no other general or systemic findings. Investigations revealed normal renal function with proteinuria of 3-5 GM Esbach/day. His haemogram was normal with low protection and very low albumin. PTI was normal and 3 blood slides were all negative for malaria parasites. Stool examination revealed hookworm. Chest radiology was normal. Splenic aspirate revealed phagocytic macrophages containing numerous schizonts of Plasmodium malariae. Liver biopsy showed Kupffer cell hyperplasia, the cells also containing black pigments most likely due to malaria. The boy was negative for G6PD deficiency. Renal biopsy showed membrane-proliferative glomerulonephritis not typical of childhood nephrosis but consistent with the adult type of malarial nephropathy. This child was thought most likely to have nephrotic syndrome due to P. malariae (quartan malarial nephropathy), as other causes of nephrotic syndromes were excluded. This illustrative history is used to discuss the pathophysiology of quartan malarial nephropathy.