End-stage renal disease in leprosy

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Leprosy, or Hansen's disease (HAD), caused by Mycobacterium leprae, affects kidneys, leading to glomerulonephritis, renal amyloidosis (RA), and interstitial nephritis.
• While endemic in some countries, Italy has few new cases, but kidney damage and chronic renal failure are recognized complications.
• End-stage renal disease (ESRD) in leprosy patients is underreported in literature and registries.

Purpose of the Study:

• To report the long-term experience with end-stage renal disease (ESRD) in leprosy patients.
• To analyze the characteristics and outcomes of leprosy patients requiring renal replacement therapy.

Main Methods:

• Retrospective analysis of the database from the HAD Center (Gioia del Colle) and hospital records.
• Review of clinical manifestations, kidney biopsy findings, and dialysis treatment (peritoneal dialysis and hemodialysis) duration.

Main Results:

• Eight leprosy patients (six male, two female) underwent dialysis between 1980 and 2003.
• Renal amyloidosis (RA) was diagnosed in two of three biopsied patients; interstitial nephritis (IN) in one.
• Hemodialysis (HD) treatment lasted an average of 40.6 months; six patients died, and two remain on HD.

Conclusions:

• Uremia is a late complication of leprosy with multifactorial causes, frequently involving RA.
• Conventional bicarbonate hemodialysis (HD) appears effective for treating uremia in leprosy patients.
• ESRD management in leprosy requires careful consideration of underlying renal pathologies and dialysis outcomes.