**1. Introduction**

The World Health Organization (WHO) lists a group of communicable diseases that currently affects more than one billion people in more than 100 countries and cost billions of dollars every year [1]. These diseases have the common characteristics of affecting predominantly poor people living in precarious conditions, with close contact with vectors and domestic

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

animals, and also facing difficulties to access health-care facilities. The 2018 WHO list of neglected tropical diseases includes Buruli ulcer, Chagas disease, dengue, chikungunya, dracunculiasis, echinococcosis, foodborne trematodiases, human African trypanosomiasis, leishmaniasis, leprosy, onchocerciasis, rabies, scabies and other ectoparasites, schistosomiasis, soil-transmitted helminthiases, snakebite envenoming, taeniasis/cysticercosis, trachoma, yaws, lymphatic filariasis, mycetoma, chromoblastomycosis, and other deep mycoses [1]. The kidneys are frequently affected in these diseases, and in some cases, the complications increase the risk of death. In this chapter, we discuss the main neglected tropical diseases, which complicate matters with kidney involvement.

experimental studies [14, 15]. The pathophysiology of kidney involvement in Chagas disease is associated with immunological process and includes autoantibodies production [16, 17]. There are reports that in the chronic phase of the disease, glomerular deposits of IgM occur at early stages, with intense inflammatory response, resulting in immune complex formation, which leads to glomerulonephritis [9]. The exact mechanism by which *T. cruzi* causes kidney

Neglected Tropical Diseases with an Impact on Kidney Function

http://dx.doi.org/10.5772/intechopen.78981

33

Treatment of Chagas disease is based on antitrypanosomal drugs, which is indicated for all acute and congenital cases, reactivated cases, and chronic disease in individuals <18 years [3]. Specific treatment is currently recommended even for patients with the chronic forms of the disease, despite achieving lower cure rates than in acute phase [6]. The main available drugs are benznidazole (dose for adults: 5 mg/kg/day; for children: 5–10 mg/kg/day) and nifurtimox

Dengue is the most common arbovirosis in the world, there are more than 2 billion people living in endemic areas [18], and it is the second most common disease transmitted by mosquitoes, following malaria [19]. Tropical countries face repeated outbreaks of the disease. In Brazil, the most recent outbreaks have affected millions of people [20, 21]. In recent years, other arbovirosis has caused epidemics in the Caribbean region and Latin America: chikungunya fever and Zika virus infection, and renal involvement has already been reported [22–27]. Clinical manifestations vary according to patients' age, and the incubation period varies from 3 to 14 days. The majority of patients are asymptomatic or have a mild disease characterized by fever, headache, myalgia, arthralgia, retroorbital pain, and maculopapular rash, which has been known as dengue fever [19, 28]. Severe forms of the disease, characterized by coagulation disturbances, increased vascular permeability, and hemorrhagic manifestations, are classically known as dengue hemorrhagic fever and can evolve to dengue shock syndrome [19]. There is evidence that severe cases of dengue are increasing, complicating with organ

Renal abnormalities in dengue include hydroelectrolyte disturbances, acute kidney injury (AKI), and, less frequently, glomerulonephritis, rhabdomyolysis, and hemolytic uremic syndrome [18, 29–31]. AKI seems to be more frequent in adults than in children with dengue and is associated with hypotension, sepsis, multiple organ dysfunction, and use of vasoactive drugs [30–37]. Direct kidney damage caused by dengue virus is described through cytopathic effect of viral proteins on glomerular and tubular cells, associated with immunological mechanisms mediated by viral antigens deposited on glomerular structures and tissue damage by immune complex deposition [18, 31, 38]. Other factors that mediate renal lesions in Dengue are hemodynamic instability, hemolysis, rhabdomyolysis, and nephrotoxic drug use. Autopsy studies show evidence of acute tubular necrosis, predominantly in the proximal tubules, hemorrhage, and edema, more accentuated in the medullary region [29, 38]. Dengue-associated AKI usually has a favorable outcome, with recovery in around 2 weeks [18]. Among patients

(dose for adults: 8–10 mg/kg/day; for children: 15 mg/kg/day), for 60 days.

**3. Dengue and other endemic arbovirosis**

damage, including kidney involvement [14, 18].

disease is still to be elucidated [4].
