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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2016  |  Volume : 27  |  Issue : 6  |  Page : 1280-1282
Dengue nephropathy: Immunopathology and immune complexinvolvement


Visiting Professor, Tropical Medicine Department, Hainan Medical University, Haikou, China; Visiting Professor, Department of Medicine, Faculty of Medicine, University of Nis, Nis, Serbia; Adjunct Professor, Department of Biological Science Joseph Ayobabalola University, Ikeji-Arakeji, Osun State, Nigeria; Honorary Professor, Department of Community Medicine, Dr. D Y Patil Medical University, Mumbai, Maharashtra, India; Professor, Senior Expert, Surin Rajabhat University, Surin, Thailand

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Date of Web Publication28-Nov-2016
 

How to cite this article:
Wiwanitkit V. Dengue nephropathy: Immunopathology and immune complexinvolvement. Saudi J Kidney Dis Transpl 2016;27:1280-2

How to cite this URL:
Wiwanitkit V. Dengue nephropathy: Immunopathology and immune complexinvolvement. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2020 Jan 26];27:1280-2. Available from: http://www.sjkdt.org/text.asp?2016/27/6/1280/194693
To the Editor,

Dengue is an important mosquito-borne infectious disease that is presently observed worldwide. This is an arboviral infection that causes acute febrile illness with hemorrhagic complications. In general, this disease is common in the tropical Southeast and South Asia. The occurrence of the disease in several new areas including the Gulf is being reported. Amarasinghe and Letson noted that it may be due to the existence of a large immigrant workforce from dengue-endemic countries, increased travel from and to dengue-endemic countries, and increased urbanization in the Middle East. [1] Haq et al noted that it was necessary to prepare for the possible emergence of dengue in the Middle East. [2]

Dengue is classified as an acute febrile viral illness. It usually presents with three common triads; hemoconcentration, thrombocytopenia and, atypical lymphocytosis. [3] Renal disease in dengue, presenting as renal failure, is atypical but should not be overlooked. In a report, 4% of cases with acute renal failure (ARF) in a hospital in a tropical country was due to dengue infection. [4] Lizarraga and Nayer noted that ARF is a potential complication of severe dengue infection and is typically associated with hypotension, rhabdomyolysis, or hemolysis. [5] They also noted that ARF complicates severe dengue infection in 2-5% of the cases and carries a high mortality rate. Renal failure is a common cause of death in dengue fever. [5],[6] Khalil et al found that dengue patients with renal failure had a high mortality; 100% in their case series. [7] The interesting issue is the underlying pathogenesis of renal problem in dengue, which is not well understood. There are many possibilities. The renal disease might be due to direct viral invasion of the kidney or the consequence of hemodynamic fluctuation in its clinical course. In patients with dengue and shock, it is easy to understand the involvement of the kidneys. However, in cases without shock, renal failure can still occur. In such cases, rhabdomyolysis might be the cause of acute tubular necrosis. [8],[9],[10]

Adding to the non-immunologic mechanisms, immunologic mechanisms might also play a role. The observation of renal problem occurring in dengue hemorrhagic fever in the absence of shock, sepsis, hemolysis, or rhabdomyolysis is very interesting. [11] A recent report by Bhagat et al on a case with deranged renal function and low serum complement C3 draws attention to the possibility of immunological mechanisms underlying dengue nephropathy. [11] Lizarraga and Nayer proposed that dengue infection is associated with systemic autoimmune disorders, which on rare occasions might involve the kidneys. [5] Immunocomplex formation has been shown in dengue. [12] In a previous study by Wiwanitkit, it was found that the diameter of derived complex is much smaller, compared with the diameter of glomerulus, and concluded that immune-complexes may not have a significant role in the pathogenesis of renal failure in dengue infection. [12] This means that immune-complex-induced renal disorders may not be found in dengue fever. [12] On the other hand, it is possible that there might be some underlying renal disorders that might allow immune complexes to cause renal involvement. Of interest, there are some reports on immune-complex-induced renal disorder in dengue patients with the underlying renal problems. [13],[14] A good example is the previous case report on transient IgA nephropathy with acute kidney injury in a patient with dengue fever. [14] In this case report, denguerelated renal damage was immune-complexmediated; mesangial IgA-dominant immunecomplex deposits could be detected on kidney biopsy. [14] The transient observation of immuneinduced nephropathy in this case might be due to the reduced ability of immune-complex formation in the late phase of dengue infection. [15] Finally, there is a recent report that dengue viral infection can also aggravate other immune complex diseases such as systemic lupus erythematosus. [13]


   Conclusion Top


Dengue infection is an important emerging infection worldwide. This disease can induce renal disease, and immune-complex-related nephropathy is a possible pathology that should not be forgotten. This should be carefully investigated in cases with the underlying renal disease.

Conflicts of interest: None declared.

 
   References Top

1.
Amarasinghe A, Letson GW. Dengue in the Middle East: A neglected, emerging disease of importance. Trans R Soc Trop Med Hyg 2012;106:1-2.  Back to cited text no. 1
    
2.
Haq Z, Mahjour J, Khan W. Communicable diseases in the Eastern Mediterranean region: Prevention and control 2010-2011. East Mediterr Health J 2013;19:888-91.  Back to cited text no. 2
    
3.
Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther 2010; 8:841-5.  Back to cited text no. 3
    
4.
Daher Ede F, Junior Silva GB, Vieira AP, et al. Acute kidney injury in a tropical country: A cohort study of 253 patients in an infectious diseases Intensive Care Unit. Rev Soc Bras Med Trop 2014;47:86-9.  Back to cited text no. 4
    
5.
Lizarraga KJ, Nayer A. Dengue-associated kidney disease. J Nephropathol 2014;3:57-62.  Back to cited text no. 5
    
6.
Lumbiganon P, Kosalaraksa P, Thepsuthammarat K, Sutra S. Dengue mortality in patients under 18 years old: An analysis from the health situation analysis of Thai population in 2010 project. J Med Assoc Thai 2012;95 Suppl 7: S108-13.  Back to cited text no. 6
    
7.
Khalil MA, Tan J, Khalil MA, Awan S, Rangasami M. Predictors of hospital stay and mortality in dengue virus infection-experience from Aga Khan University Hospital Pakistan. BMC Res Notes 2014;7:473.  Back to cited text no. 7
    
8.
Wiwanitkit V. Acute renal failure in the fatal cases of dengue hemorrhagic fever, a summary in Thai death cases. Ren Fail 2005;27:647.  Back to cited text no. 8
    
9.
Repizo LP, Malheiros DM, Yu L, Barros RT, Burdmann EA. Biopsy proven acute tubular necrosis due to rhabdomyolysis in a dengue fever patient: A case report and review of literature. Rev Inst Med Trop Sao Paulo 2014; 56:85-8.  Back to cited text no. 9
    
10.
Póvoa TF, Alves AM, Oliveira CA, Nuovo GJ, Chagas VL, Paes MV. The pathology of severe dengue in multiple organs of human fatal cases: Histopathology, ultrastructure and virus replication. PLoS One 2014;9:e83386.  Back to cited text no. 10
    
11.
Bhagat M, Zaki SA, Sharma S, Manglani MV. Acute glomerulonephritis in dengue haemorrhagic fever in the absence of shock, sepsis, haemolysis or rhabdomyolysis. Paediatr Int Child Health 2012;32:161-3.  Back to cited text no. 11
    
12.
Wiwanitkit V. Immune complex: Does it have a role in pathogenesis of renal failure in dengue infection? Ren Fail 2005;27:803-4.  Back to cited text no. 12
    
13.
Rajadhyaksha A, Mehra S. Dengue fever evolving into systemic lupus erythematosus and lupus nephritis: A case report. Lupus 2012; 21:999-1002.  Back to cited text no. 13
    
14.
Upadhaya BK, Sharma A, Khaira A, Dinda AK, Agarwal SK, Tiwari SC. Transient IgA nephropathy with acute kidney injury in a patient with dengue fever. Saudi J Kidney Dis Transpl 2010;21:521-5.  Back to cited text no. 14
  Medknow Journal  
15.
Wiwanitkit V. Weak binding affinity of immunoglobin G, an explanation for the immune mimicking theory in pathophysiologic findings in the recovery phase of dengue. Nanomedicine 2005;1:239-40.  Back to cited text no. 15
    

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Correspondence Address:
Viroj Wiwanitkit
Visiting Professor, Tropical Medicine Department, Hainan Medical University, Haikou, China; Visiting Professor, Department of Medicine, Faculty of Medicine, University of Nis, Nis, Serbia; Adjunct Professor, Department of Biological Science Joseph Ayobabalola University, Ikeji-Arakeji, Osun State, Nigeria; Honorary Professor, Department of Community Medicine, Dr. D Y Patil Medical University, Mumbai, Maharashtra, India; Professor, Senior Expert, Surin Rajabhat University, Surin, Thailand

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DOI: 10.4103/1319-2442.194693

PMID: 27900982

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