Abstract
BackgroundWe aimed to evaluate urinary MCP-1 and oxidative stress through urinary malondialdehyde (MDA) in leprosy and correlate them with traditional, but less sensitive markers of renal disease.MethodsThis is a cross-sectional study of 44 patients with diagnosis of leprosy and no previous treatment. Skin smear was assessed through a bacteriological index - from 0 to 6+. Glomerular filtration rate (GFR), protein excretion rate, microalbuminuria, urinary oxidative stress, malondialdehyde (MDA) and urinary MCP-1 were measured. Also, high- sensitivity C-reactive protein (hs-CRP) was measured in the blood. Fifteen healthy subjects composed a control group.ResultsAge and gender were similar between leprosy patients and control groups. No patient had a GFR < 60 mL/min/1.73 m2 or albumin excretion rate greater than 30 mg/g-Cr. Leprosy patients had higher urinary protein excretion (97.6 ± 69.2 vs. 6.5 ± 4.3 mg/g-Cr, p < 0.001), urinary MCP-1 (101.0 ± 79.8 vs. 34.5 ± 14.9 mg/g-Cr, p = 0.006) and urinary MDA levels (1.77 ± 1.31 vs. 1.27 ± 0.66 mmol/g-Cr, p = 0.0372) than healthy controls. There was a positive correlation between urinary MCP-1 and bacteriological index in skin smears (r = 0.322, p = 0.035), urinary protein excretion (r = 0.547, p < 0.001), albumin excretion rate (r = 0.414, p = 0.006) and urinary MDA (r = 0.453, p = 0.002). After adjusting for hs-CRP, urinary MCP-1 remained correlated with albumin excretion rate (rpartial = 0.483, p = 0.007) and MDA levels (rpartial = 0.555, p = 0.001).ConclusionLeprosy patients with no clinical kidney disease have increased urinary MCP-1 mainly in lepromatous polar form. Inflammatory (MCP-1) and oxidative stress markers suggest leprosy patients are at high risk of developing kidney disease.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-451) contains supplementary material, which is available to authorized users.
Highlights
We aimed to evaluate urinary monocyte chemotactic protein-1 (MCP-1) and oxidative stress through urinary malondialdehyde (MDA) in leprosy and correlate them with traditional, but less sensitive markers of renal disease
We aimed to evaluate urinary MCP-1 and oxidative stress through urinary malondialdehyde (MDA) in leprosy patients in comparison with a healthy control group and correlate them with traditional, but less sensitive markers of renal disease
No patient had chronic kidney disease according to Kidney Disease Outcomes Quality Initiative definition - glomerular filtration rate higher than 60 mL/min/1.73 m [2] and albumin excretion rate less than 30 mg/g-Cr
Summary
We aimed to evaluate urinary MCP-1 and oxidative stress through urinary malondialdehyde (MDA) in leprosy and correlate them with traditional, but less sensitive markers of renal disease. Renal lesions in leprosy patients can be present in up to 72% of leprosy patients in autopsied patients [3]; clinical manifestation can be subtle. A few patients show a fast decline in renal function or major proteinuria associated with edema. These uncommon cases are published as case reports, due to their rarity [4,5]. Many other leprosy patients can be at risk for developing kidney disease. Identification of these patients is difficult in part due to lack of sensitivity of diagnostic tests used in clinical practice to detect incipient renal disease
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