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India is responsible for about 40% of global cases of filariasis, with a predominant distribution in the eastern and north-eastern states of the country. Odisha was formerly recognized as one of the regions with the highest prevalence. Lymphatic filariasis is attributed to the pathogens Brugia malayi and Wuchereria bancrofti. Filariasis is well acknowledged to exhibit a spectrum of lymphatic and extra-lymphatic symptoms in clinical manifestations. Renal symptoms that may manifest in these patients include asymptomatic proteinuria, chyluria, nephrotic syndrome (NS), or acute glomerulonephritis (GN).
We retrospectively analyzed the data of all patients undergoing renal biopsy in the department of nephrology at the All India Institute of Medical Sciences from March 2021 to September 2023. The epidemiological, clinical, and kidney histopathological data of the patients who were suffering from chronic filariasis have been collected.
As a result, 8 patients out of 932 renal biopsies had chronic filariasis, which was characterized by either unilaterally or bilaterally swelling of the lower limb, mostly lymphedema with thickened skin thrown into folds and dark pigmentation. The mean duration from the diagnosis of filariasis to the onset of glomerular diseases was 15.75 years. Indications for biopsy in 7 patients were NS and unexplained renal dysfunction in 1 patient. The mean 24 urinary protein, serum albumin, and serum creatinine at presentation were 7.4125 g/day, 2.51 g/dL, and 1.2 mg/dL, respectively. Three patients had microspic hematuria, and one had chyluria. All patients had received diethylcarbamazine in the past. Five patients were male, and the mean age was 49.125 years. In a group of seven NS patients, three had membranous nephropathy, two had minimal change disease and IGA nephropathy, and one had membranoproliferative GN. None of the biopsy results showed microfilaria in the renal tissue. Other than IGAN cases, all other patients had responded to immunosuppressive therapy.
The presence of kidney involvement in chronic filariasis can manifest as a range of glomerular disorders. However, the exact determination of causation in this context remains uncertain.