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| LETTER TO EDITOR |
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| Year : 2016 | Volume
: 26
| Issue : 4 | Page : 312-313 |
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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
| Date of Web Publication | 1-Jul-2016 |
Correspondence Address:
G Li Cavoli
Via Francesco Cilea 43, Palermo 90144
Italy
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-4065.179303
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;26:312-3 |
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: Renal biopsy. Light microscopy: Global and prominent thickening of the glomerular basement membranes. (PAS, ×400)
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 | Figure 2: Renal biopsy. Immunofluorescence: Diffuse deposition of IgG along the glomerular capillary walls
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Tollitt J, Duncan A, Woywodt A. Of mites and men: Scabies in patients with kidney disease. Clin Kidney J 2013;6:125-7.  |
| 2. | Chung 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. |
| 3. | Hoy W, McDonald SP. Albuminuria: Marker or target in indigenous populations. Kidney Int Suppl 2004;92:S25-31. |
| 4. | Walker KA, Wang Z. The multidimensional nature of renal disease: Rates and associations of albuminuria in an Australian Aboriginal community. Kidney Int 1998;54:1296-304. [ PUBMED] |
| 5. | Marshall 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. |
[Figure 1], [Figure 2]
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