Acute obstructive urinary schistosomiasis mimicking clinical glomerulonephritis: an unrecognized syndrome

Urinary schistosomiasis presenting with the clinical signs of acute glomerulonephritis is described in 20 African children. Nineteen had oedema, 10 had circulatory overload, 11 had hypertension, 12 had oligoanuria and all had obstructive uropathy with hydronephrosis. Lack of support for a diagnosis of post-streptococcal glomerulonephritis (PSGN) was the absence in these patients of a raised anti-streptolysin 0 titre and marked reduction in C3, which are noted in about 93% of those with PSGN. Furthermore, casts were not detected in freshly voided urine. Six of these patients required peritoneal dialysis. Signs in 16 reverted to normal within 3 weeks and two children died. One child had severe interstitial fibrosis and dilated and atrophic tubules with normal glomeruli, and died 18 months later in renal failure; the other had disseminated schistosomiasis and focal areas of chronic inflammatory cells with fibrin thrombi in small vessels in the kidney and died 6 days after admission. Obstructive uropathy cleared within 4-12 weeks in all seven patients who were followed up. Preliminary findings in a few children suggest a non-glomerular origin for this disease: a tubulo-interstitial disorder secondary to obstructive uropathy seems the most likely cause of this clinical problem. As renal biopsies were not ethically indicated, it is not possible to exclude PSGN completely in all these children. This syndrome could have escaped notice and may have been interpreted as glomerulonephritis with associated bilharzia, and therefore may constitute a previously unrecognized complication of Schistosoma haematobium infestation.