Perfil de quimiocinas na urina e no soro de pacientes com a glomerulopatia da esquistossomose mansônica hepatoesplênica

Abstract

Introduction: Renal involvement has been described in 15% of patients with hepatosplenic schistosomiasis mansoni. Peripheral edema, systemic arterial hypertension and/or proteinuria signal the presence of renal disease in such patients. There have been no studies on the profile of chemokines in the serum and urine of patients with schistosomal glomerulopathy. Objetive: We investigated the sera and urine levels of chemokines in patients with hepatosplenic schistosomiasis, with and without renal disease, aiming at defining a profile which might suggest kidney injury on the course of hepatosplenic schistosomiasis. Methodoly: This is a cross-sectional study developed at the Outpatient Clinic of the Infectious and Parasitic Diseases Unit, Federal University of Minas Gerais, Belo Horizonte, in Brazil, between October 2008 and July 2010. After informed consent, 160 volunteers with a median age of 40 years were enrolled in the study and divided into five groups: 1) sixty eight patients had hepatosplenic schistosomiasis mansoni without renal disease; 2) twelve had hepatosplenic schistosomiasis with renal disease; 3) twenty seven had hepatointestinal schistosomiasis; 4) twenty two had glomerulopathy of varied causes, withou schistosomiasis; and 5) thirty one were apparently healthy. All participants were submitted to clinical examination. Those with microalbuminuria above 30mg in 24 hours were considered as having renal disease. In eight patients with microalbuminuria and schistosomiais the presence of glomerulopathy was confirmed by renal biopsy. Diagnosis of hepatosplenic schistosomiasis was established by the association of epidemiological, clinical, parasitological and ultrasound data. From all participants, sera samples and a small quantity of urine (taken from the 24 hour urine collected) were obtained and stored at -80oC. The sera and urine chemokines MCP-1/CCL2, MIP-1/CCL3, IL-8/CXCL8, eotaxin/CCL11 and RANTES/CCL5 were measured using an ELISA test and commercial kits. Information obtained was transferred to a data bank (EpiData 3.1) and analyzed in the SPSS software. Results: In patients with hepatosplenic schistosomiasis and renal disease the following chemokine profile was found: MIP-1 in the urine >14.3pg/ml, sera MIP-1 >61.9pg/ml, IL-8 in the sera <1,030pg/ml, eotaxin in the urine >26.7pg/ml and sera MCP-1 >634pg/ml. A similar profile was observed in the group of patients with glomerulopathy caused by other diseases (without schistosomiasis), except for serum MCP-1 that was <634pg/ml. Patients with hepatosplenic schistosomiasis without renal disease presented the following profile: MIP-1 in the urine <14.3pg/ml, serum MCP-1 <490pg/ml and RANTES <11,509pg/ml. The other groups presented different profiles. Conclusion: In cases with serum MCP-1 >634pg/ml the diagnosis of schistosomal glomerulopathy should be considered.