NDT Advance Access originally published online on September 26, 2007
Nephrology Dialysis Transplantation 2008 23(1):256-262; doi:10.1093/ndt/gfm568
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Evaluation of renal function in leprosy: a study of 59 consecutive patients
1Department of Internal Medicine, School of Medicine, Federal University of Ceará, Barbalha, CE, 2Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, CE, 3Department of Statistics, Federal University of Ceará, Fortaleza, CE, 4Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Fortaleza, CE and 5Department of Nephrology, University of São Paulo, Brazil
Correspondence to: Dra. Elizabeth De Francesco Daher, Rua Vicente Linhares, 1198, 60135-270 Fortaleza, CE, Brazil. Email: ef.daher{at}uol.com.br
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Abstract |
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Background. Renal abnormalities in leprosy have been largely described in medical literature, but there are few studies evaluating renal function in these patients.
Methods. This is a cross-sectional study in 59 consecutive paucibacillary (PB) and multibacillary (MB) leprosy patients. Glomerular filtration rate (GFR) was estimated by simplified-MDRD formula. Microalbuminuria was determined by 24 h urine collection. Urinary acidification capacity was measured after water deprivation and acid-loading with CaCl2. Urinary concentration capacity was evaluated after desmopressin acetate administration, using the urinary to plasma osmolality (U/Posm) ratio. All parameters except microalbuminuria were measured in a control group of 18 healthy volunteers.
Results. Age and gender were similar between leprosy (MB or PB) and control groups. GFR 
80 ml/min/1.73 m2 was observed in 50% of the leprosy patients. GFR and U/Posm in leprosy patients were significantly lower than in controls (P < 0.001). Urinary acidification defect was found in 32% of PB and in 29% of MB patients and urinary concentrating ability was abnormal in 83% of PB and 85% of MB patients. Microalbuminuria was found in 4 patients (8.5%), leukocyturia was found in 13 (22%) and haematuria was present in 16 patients (27%). Plasma creatinine (Pcr) >1.2 mg/dl was observed in 17.9% of MB patients and in none of the controls (P = 0.020). A negative correlation was observed between GFR and time of treatment (r = –0.339; P = 0.002). Age and time of treatment were independent risk factors for GFR 80 ml/min/1.73 m2 in multivariate analysis.
Conclusions. Asymptomatic GFR changes and renal tubular dysfunction, including urine concentration defect and impaired acidifying mechanisms, can be caused by leprosy on specific treatment and without any reaction episodes.
Keywords: leprosy; renal function; renal tubular acidosis; tubular dysfunction; urinary osmolarity.