Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2017  |  Volume : 28  |  Issue : 3  |  Page : 668--669

Author’s reply


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

Correspondence Address:
Prof. Viroj Wiwanitkit
Department of Tropical Medicine, Hainan Medical University, Haikou; Department of Medicine, Faculty of Medicine, University of Nis, Nis; Department of Biological Science Joseph Ayobabalola University, Ikeji-Arakeji, Osun State; Department of Community Medicine, Dr. D Y Patil Medical University, Mumbai, Maharashtra; Surin Rajabhat University, Surin




How to cite this article:
Wiwanitkit V. Author’s reply.Saudi J Kidney Dis Transpl 2017;28:668-669


How to cite this URL:
Wiwanitkit V. Author’s reply. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2020 Jul 7 ];28:668-669
Available from: http://www.sjkdt.org/text.asp?2017/28/3/668/206454


Full Text

To the Editor,

It is very glad to receive the letter from Mallhi et al on my published article Dengue nephropathy: Immunopathology and immune complex involvement.[1] Mallhi et al suggested “prospective follow-up studies to ascertain the postacute kidney injury (AKI) epidemiology in dengue infection. In addition, consensus to define renal recovery in dengue patients’ needs attention.”

As noted by Mallhi et al, “there are no specific recommendations for either conservative treatment or dialysis in patients with dengue, and the effects of AKI on the quality of life and survival.” These comments are agreeable and should be interesting points for further studies. Focusing on the renal problem as a long-term consequence of dengue infection, there is still no report to support this idea. However, it is possible. In the endemic areas, seropositivity against dengue is common among the local population, and a similar high seropositive rate might be expected for patients with renal problems. According to the proposed mechanism of immune complex formation that might affect kidney, long-term complications can be expected. The recent case report by Lizarraga et al is a good supporting evidence that autoimmunity and immune complex formation can lead to nephropathy due to dengue infection.[2] An interesting question is whether such immune- induced nephropathy in dengue can be reversible or not. According to a recent report by Upadhaya et al,[3] reversibility has been observed. At present, there are no guidelines for long- term follow-up of postdengue infection renal function. Nevertheless, based on the observation in my setting, where dengue is highly prevalent, there is still no problem of post- dengue chronic renal failure among infected children. As noted, dengue IgM during acute dengue infection is the main cause of any immune-pathological process in dengue, and hence, self-recovery of the thrombocytopenia is possible. A similar process might be expected in cases with nephropathy.[4] At present, the ideal suggestion is the intensive fluid therapy for any case with acute dengue infection.

References

1Wiwanitkit V. Dengue nephropathy: Immuno- pathology and immune complexinvolvement. Saudi J Kidney Dis Transpl 2016;27:1280-2.
2Lizarraga KJ, Florindez JA, Daftarian P, et al. Anti-GBM disease and ANCA during dengue infection. Clin Nephrol 2015;83:104-10.
3Upadhaya 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.
4Wiwanitkit 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.