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Original ArticlesGlomerular and Tubulointerstitial Diseases
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Malaria, Collapsing Glomerulopathy, and Focal and Segmental Glomerulosclerosis

Ariane Amoura, Anissa Moktefi, Matthieu Halfon, Alexandre Karras, Cédric Rafat, Jean-Baptiste Gibier, Patrick J. Gleeson, Aude Servais, Nicolas Argy, Pascale Maillé, Xavier Belenfant, Victor Gueutin, Alexia Delpierre, Leila Tricot, Khalil El Karoui, Noémie Jourde-Chiche, Sandrine Houze, Dil Sahali and Vincent Audard
CJASN July 2020, 15 (7) 964-972; DOI: https://doi.org/10.2215/CJN.00590120
Ariane Amoura
1Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France
2Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
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Anissa Moktefi
2Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
3Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
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Matthieu Halfon
4Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Service de Néphrologie, Paris, France
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Alexandre Karras
5Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Néphrologie, Paris, France
6Faculté de Médecine Paris-Descartes, Université de Paris, Paris, France
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Cédric Rafat
7Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
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Jean-Baptiste Gibier
8University of Lille, Centre Hospitalier Universitaire de Lille, Institut de Pathologie, Centre de Biologie Pathologie, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1172, Lille, France
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Patrick J. Gleeson
9Institut National de la Santé et de la Recherche Médicale U1149, Immunoreceptors and Renal Immunopathology Laboratory, Université Diderot, Paris, France
10Royal College of Physicians of Ireland, Division of Nephrology, Dublin, Republic of Ireland
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Aude Servais
11Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Paris, France
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Nicolas Argy
12Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Laboratoire de Parasitologie-Mycologie Médicale, Centre National de Référence du Paludisme, Paris, France
13Institut pour la Recherche et le Développement, Université de Paris, Faculté de Pharmacie, Mère et enfant en milieu tropical Unité Mixte de Recherche 261, Paris, France
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Pascale Maillé
3Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
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Xavier Belenfant
14Groupe Hospitalier Grand Paris Nord Est, Hôpital André Grégoire, Service de Néphrologie-Dialyse, Montreuil, France
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Victor Gueutin
15Association pour l’Utilisation du Rein Artificiel, Service de Néphrologie-Dialyse, Association pour l’Utilisation du Rein Artificiel Paris Plaisance, Paris, France
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Alexia Delpierre
16Hôpital Duchenne, Service de Néphrologie et Médecine Interne, Boulogne sur Mer, France
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Leila Tricot
17Hôpital Foch, Service de Néphrologie, Transplantation Rénale et Dialyse, Suresnes, France
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Khalil El Karoui
1Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France
2Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
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Noémie Jourde-Chiche
18Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institut national de recherche pour l’agriculture, l’alimentation et l’environnement, Centre de recherche en CardioVasculaire et Nutrition, Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
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Sandrine Houze
12Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Laboratoire de Parasitologie-Mycologie Médicale, Centre National de Référence du Paludisme, Paris, France
13Institut pour la Recherche et le Développement, Université de Paris, Faculté de Pharmacie, Mère et enfant en milieu tropical Unité Mixte de Recherche 261, Paris, France
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Dil Sahali
1Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France
2Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
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Vincent Audard
1Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France
2Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
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Abstract

Background and objectives Malaria, a potentially life-threatening disease, is the most prevalent endemic infectious disease worldwide. In the modern era, the spectrum of glomerular involvement observed in patients after malarial infections remains poorly described.

Design, setting, participants, & measurements We therefore performed a retrospective multicenter study to assess the clinical, biologic, pathologic, and therapeutic characteristics of patients with glomerular disease demonstrated by kidney biopsy in France within 3 months of an acute malaria episode.

Results We identified 23 patients (12 men), all but 1 of African ancestry and including 10 patients with concomitant HIV infection. All of the imported cases were in French citizens living in France who had recently traveled back to France from an endemic area and developed malaria after their return to France. Eleven patients had to be admitted to an intensive care unit at presentation. Plasmodium falciparum was detected in 22 patients, and Plasmodium malariae was detected in 1 patient. Kidney biopsy was performed after the successful treatment of malaria, a mean of 24 days after initial presentation. At this time, all patients displayed AKI, requiring KRT in 12 patients. Nephrotic syndrome was diagnosed in 17 patients. Pathologic findings included FSGS in 21 patients and minimal change nephrotic syndrome in 2 patients. Among patients with FSGS, 18 had collapsing glomerulopathy (including 9 patients with HIV-associated nephropathy). In four patients, immunohistochemistry with an antibody targeting P. falciparum histidine-rich protein-2 demonstrated the presence of the malaria antigen in tubular cells but not in podocytes or parietal epithelial cells. An analysis of the apoL1 risk genotype showed that high-risk variants were present in all seven patients tested. After a mean follow-up of 23 months, eight patients required KRT (kidney transplantation in two patients), and mean eGFR for the other patients was 51 ml/min per 1.73 m2.

Conclusions In patients of African ancestry, imported Plasmodium infection may be a new causal factor for secondary FSGS, particularly for collapsing glomerulopathy variants in an APOL1 high-risk variant background.

  • FSGS
  • collapsing glomerulopathy
  • minimal change nephrotic syndrome
  • kidney biopsy
  • malaria infection
  • APOL1 protein
  • human
  • HIV-Associated Nephropathy
  • nephrotic syndrome
  • HIV Infections
  • immunohistochemistry
  • Follow-Up Studies
  • Received January 14, 2020.
  • Accepted April 29, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (7)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 7
July 01, 2020
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Malaria, Collapsing Glomerulopathy, and Focal and Segmental Glomerulosclerosis
Ariane Amoura, Anissa Moktefi, Matthieu Halfon, Alexandre Karras, Cédric Rafat, Jean-Baptiste Gibier, Patrick J. Gleeson, Aude Servais, Nicolas Argy, Pascale Maillé, Xavier Belenfant, Victor Gueutin, Alexia Delpierre, Leila Tricot, Khalil El Karoui, Noémie Jourde-Chiche, Sandrine Houze, Dil Sahali, Vincent Audard
CJASN Jul 2020, 15 (7) 964-972; DOI: 10.2215/CJN.00590120

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Malaria, Collapsing Glomerulopathy, and Focal and Segmental Glomerulosclerosis
Ariane Amoura, Anissa Moktefi, Matthieu Halfon, Alexandre Karras, Cédric Rafat, Jean-Baptiste Gibier, Patrick J. Gleeson, Aude Servais, Nicolas Argy, Pascale Maillé, Xavier Belenfant, Victor Gueutin, Alexia Delpierre, Leila Tricot, Khalil El Karoui, Noémie Jourde-Chiche, Sandrine Houze, Dil Sahali, Vincent Audard
CJASN Jul 2020, 15 (7) 964-972; DOI: 10.2215/CJN.00590120
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Keywords

  • FSGS
  • collapsing glomerulopathy
  • minimal change nephrotic syndrome
  • kidney biopsy
  • malaria infection
  • APOL1 protein
  • human
  • HIV-Associated Nephropathy
  • nephrotic syndrome
  • HIV Infections
  • immunohistochemistry
  • Follow-Up Studies

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