**7. Conclusion**

dysfunction also occurs in schistosomiasis, mainly urinary concentration dysfunction, which can be found in as high as 85% of patients with the hepatosplenic form in endemic areas [93]. Even in patients infected with *S. mansoni*, without clinically significant disease, there is evidence of renal inflammation, which was shown through increased urinary levels of MCP-1 [94].

Treatment is based on specific drugs, the first choice being praziquantel [80, 82], which has action against all *Schistosoma* species and provides cure rates above 80% [82]. The recommended dose is 40 mg/kg for *S. haematobium* and *S. mansoni*, and 60 mg/kg for *S. japonicum* [82]. **Table 1** summarizes the main aspects of kidney involvement in the neglected tropical diseases

**Figure 1** illustrates the general pathophysiology of kidney involvement in tropical infectious

Deposits of IgM, IgG, C3, mesangial deposits, renal infarction, tubulointerstitial damage, renal infarction

and less frequently IgA, acute tubular necrosis, glomerulonephritis

Deposits of IgM, IgG, C3, different types of glomerulonephritis, most common: mesangial and membranoproliferative, tubulointerstitial lesions, amyloidosis, tubular dysfunction

Deposits of IgM, IgG, C3, different types of glomerulonephritis, mainly mesangial and membranoproliferative, but also rapidly progressive glomerulonephritis, tubulointerstitial nephritis, amyloidosis, tubular dysfunction

C3, different types of glomerulonephritis, mainly mesangial and membranoproliferative, amyloidosis, tubular dysfunction

AKI: acute kidney injury; CKD: chronic kidney disease; NGAL: neutrophil gelatinase-associated lipocalin; MCP-1:

—

—

NGAL, early predictor of AKI, associated with microalbuminuria

MCP-1, associated with renal inflammation

MCP-1, associated with renal inflammation

**Disease AKI CKD Histopathological features Novel biomarkers**

associated with cardiac involvement and heart failure

Possible, associated with amyloidosis and other complications

associated with amyloidosis and other complications

**Schistosomiasis** Yes Not common Deposits of IgM, IgG,

**Dengue** Yes Rare Deposits of IgM, IgG, C3,

discussed in this chapter.

and parasitic diseases.

**Chagas** Yes Probable,

38 Current Topics in Tropical Emerging Diseases and Travel Medicine

with drugs, mainly amphotericin B

**Leprosy** Yes Possible,

**Leishmaniasis** Yes, associated

monocyte chemoattractant protein-1.

**Table 1.** Kidney involvement in neglected tropical diseases.

Neglected tropical diseases represent a global public health problem, affecting billions of people and requiring billions of dollars to treat and control. Authorities should have in mind that the key approach to these diseases, including kidney disease itself, is prevention, which is far from ideal, mainly in the developing world. Governments should also have in mind that the main determinant factors for the perpetuation of the neglected tropical diseases in the world in the sum of poor living conditions (lack of sanitation, potable water, piped water, garbage collection, education, domestic animal control, disease-vector control, environmental problems, lack of urbanization plans, and many others), and they have responsibility for the control of these diseases [95]. Many complications can arise from these diseases, and one of the most frequent and severe is kidney disease. The main pathophysiologic factors include immunological phenomena and hemodynamic abnormalities. Endemic diseases, such as dengue, chikungunya, and Zika virus infection, which have affected millions of people in the last few years, are having increasing evidences of kidney involvement in severe cases. In the majority of cases, kidney involvement in these diseases develops as a complication when the patient has poor or delayed access to health care. Research is being conducted to better control these diseases, including vaccine development. Concerning tropical diseases-associated kidney injury, the current "hot-topic" research is to detect this complication through novel biomarkers in order to provide an early and more specific management aiming to avoid or stop renal function loss and then prevent permanent renal insufficiency. Physicians attending patients with tropical diseases should always evaluate renal function, once renal involvement is frequent, and renal recovery is possible if adequate management is provided.
