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Spectrum of Kidney Pathology in Patients With Syphilis.
Diana Fang1, Aaron J Storey2, Samar I Hassen2
1Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Kidney International Reports
|July 9, 2025
Summary
Syphilis is linked to various kidney diseases, often presenting as acute kidney injury (AKI). This study analyzed kidney biopsies from 102 syphilis patients, revealing diverse histopathologic findings and common coinfections.
Area of Science:
- Nephrology
- Infectious Diseases
- Pathology
Background:
- Syphilis is known to cause kidney disease, but studies are often limited in scope.
- Understanding the full spectrum of renal pathology in syphilis is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the histopathologic spectrum of kidney diseases associated with active syphilis.
- To analyze the clinicopathologic features of syphilis-related kidney diseases in a large patient cohort.
Main Methods:
- Retrospective analysis of native kidney biopsies from patients with confirmed active syphilis.
- Identification of patients through medical records and serologic testing (rapid plasma reagin, venereal disease research laboratory, antitreponemal antibodies).
Main Results:
- 102 patients with syphilis and kidney biopsies were identified; 87.3% were male, with a mean age of 41.0 years.
- The majority presented with acute kidney injury (AKI). Common diagnoses included membranous nephropathy (MN), HIV-associated nephropathy, acute interstitial nephritis (AIN), and acute tubular injury (ATI).
- Coinfections (HIV, HBV, HCV) were frequent, and associated kidney pathologies were observed, including collapsing glomerulopathy in HIV-infected patients.
Conclusions:
- Syphilis is associated with a wide range of kidney pathologies, frequently presenting as AKI.
- Coinfections and their related kidney damage are common in patients with syphilis.
- Histopathologic findings vary, with MN, HIV-associated diseases, AIN, and ATI being prominent.
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