J Korean Med Sci.  2012 Apr;27(4):446-449. 10.3346/jkms.2012.27.4.446.

Immunoglobulin A Nephropathy Associated with Plasmodium falciparum Malaria

• Yoo DE
• Kim JH
• Kie JH
• Park Y
• Chang TI
• Oh HJ
• Kim SJ
• Yoo TH
• Choi KH
• Kang SW
• Han SH

• KMID: 2157908
• DOI: http://doi.org/10.3346/jkms.2012.27.4.446

Abstract

Glomerulonephritis occurs as a rare form of renal manifestation in Plasmodium falciparum malaria. Herein, we report a case of falciparum malaria-associated IgA nephropathy for the first time. A 49-yr old male who had been to East Africa was diagnosed with Plasmodium falciparum malaria. Microhematuria and proteinuria along with acute kidney injury developed during the course of the disease. Kidney biopsy showed mesangial proliferation and IgA deposits with tubulointerstitial inflammation. Laboratory tests after recovery from malaria showed disappearance of urinary abnormalities and normalization of kidney function. Our findings suggest that malaria infection might be associated with IgA nephropathy.

Keyword

Glomerulonephritis; IgA nephropathy; Malaria; Plasmodium falciparum

MeSH Terms

Acute Kidney Injury/etiology/pathology
Antimalarials/therapeutic use
Creatinine/blood
Glomerulonephritis, IGA/*diagnosis/*etiology
Hematuria/etiology
Humans
Immunoglobulin A/*metabolism
Malaria/*complications/drug therapy/*pathology
Male
Middle Aged
Plasmodium falciparum/*isolation & purification
Proteinuria/etiology
Quinine/therapeutic use

Figure

• 

  Fig. 1 Pathologic findings in a patient with P. falcifarum-associated immunoglobulin A (IgA) nephropathy. (A) The renal biopsy specimen showed mild mesangial proliferation and expansion (original magnification × 400). (B) Acute and chronic inflammatory cell infiltration in the tubulointerstitium with multifocal hemosiderin casts (original magnification × 200). (C) Direct immunofluorescence showed mesangial staining for IgA (2+). (D) Electron microscopy showed multifocal electron-dense deposits within the mesangium and irregularly thickened glomerular basement membrane ranging from 800 nm to 1,200 nm in thickness. Diffusely effaced foot processes were also observed.

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  Fig. 2 Changes in kidney function and urine findings during the course of disease. d; day, m; month, y; year, PCR; protein-creatine ratio.

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