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Year : 2016  |  Volume : 26  |  Issue : 4  |  Page : 312--313

Membranous glomerulonephritis overlapping with scabies

G Li Cavoli, L Bono, C Tortorici, TV Li Cavoli, U Rotolo 
 Department of Nephrology-Dialysis, Civico and Di Cristina Hospital, Palermo, Italy

Correspondence Address:
G Li Cavoli
Via Francesco Cilea 43, Palermo 90144
Italy

How to cite this article:
Cavoli G L, Bono L, Tortorici C, Li Cavoli T V, Rotolo U. Membranous glomerulonephritis overlapping with scabies.Indian J Nephrol 2016;26:312-313

How to cite this URL:
Cavoli G L, Bono L, Tortorici C, Li Cavoli T V, Rotolo U. Membranous glomerulonephritis overlapping with scabies. Indian J Nephrol [serial online] 2016 [cited 2019 Dec 7 ];26:312-313
Available from: http://www.indianjnephrol.org/text.asp?2016/26/4/312/179303

Full Text



Sir,

Today, scabies affects to 300 million people worldwide. The disease is strongly associated with wars, migration, poverty and overcrowding.[1] This mites' infestation can predispose affected subjects to kidney disease.[2] In the survey of Hoy and McDonald, in children of 5-17 years the albumin/creatinine ratio correlated significantly with scabies.[3] Occurrence of poststreptococcal glomerulonephritis (PSGN), acute rheumatic fever and systemic sepsis are wellknown complications of scabies infestation.[4] PSGN is the most documented complication of scabies.[5] It has been postulated that antibodies to mite antigens cross-react with basement membrane antigens. There are few histological reports on renal involvement in scabies. A 20-year-old male, born in Somalia, with a previously good health, landed in Italy and was admitted to hospital because of dyspnea, malnutrition (height: 175 cm, weight 47 Kg; BMI: 15.34 Kg/m 2) and generalized pruritus. The physical examination revealed diffuse linear excoriations disseminated all over his body and severe edema in the lower extremities. The laboratory examinations showed: proteinuria 7.4 g/day; albumin: 1.18 g/dl; creatinine: 4.02 mg/dl; reactive C-Protein 26.83 mg/dl (n.v. 0-0.3); total leucocyte 21,260/µL; hemoglobin: 6,8 gr/dl; coagulation and liver function tests were unremarkable and other immunological (ASLO, immunoglobulin, extractable nuclear antigens, C3 and C4) and microbiological (hepatitis B virus, hepatitis C virus, HIV, Filaria and Leptospira) investigations were negative. The microscopic investigation of a stool sample showed no abnormal findings. The instrumental examinations showed pleural and pericardial effusion. The dermoscopy demonstrated the mites' infestation. On biopsy, 6 out of 20 glomeruli were globally sclerotic; the remaining glomeruli showed diffuse and global thickening of the capillary wall [Figure 1]; the Jones stain demonstrated the spikes in capillary walls; no vascular or tubulointerstitial lesions were seen. The immunofluorescence examination displayed granular deposition of IgG, IgM and fibrinogen along the glomerular capillary (subepithelial) walls [Figure 2]. These findings supported the diagnosis of a stage III Membranous Gomerulonephritis. The patient was treated with topical treatment of 25% benzyl benzoate, albumin I.V. and furosemide. The Patient improved gradually. After two cycles of topical therapy, we observed the disappearance of itching, creatinine 0.80 mg/dl and proteinuria 2 gr/day. The patient was lost to follow-up because he continued his journey. This neglectedparasitic disease is a major public health problem in resource-poor regions. Dysregulation of the immune system can produce the deposition of immunoimmunoglobulins along the capillary walls. To our knowledge, there are not reports on scabies combined with membranous nephropathy.{Figure 1}{Figure 2}

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References

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2Chung SD, Wang KH, Huang CC, Lin HC. Scabies increased the risk of chronic kidney disease: A 5-year follow-up study. J Eur Acad Dermatol Venereol 2014;28:286-92.
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5Marshall CS, Cheng AC, Markey PG, Towers RJ, Richardson LJ, Fagan PK, et al. Acute post-streptococcal glomerulonephritis in the Northern Territory of Australia: A review of 16 years data and comparison with the literature. Am J Trop Med Hyg. 2011;85:703-10.