The relationship between kidney disease and parasites dates back to ancient times. The Ebers papyrus (1550 BCE) contained the description of a “bloody urine disease” caused by a “worm” that would later be identified as schistosomiasis. Surprisingly, the papyrus also contained recommendations regarding prophylaxis and treatment of this ailment. A最近的文章published in theAmerican Journal of Kidney Diseasesreviews the evolution of the understanding of parasitic kidney disease since the origins of humanity until the latest discoveries in parasite molecular pathogenesis. Author Dr. Rashad S. Barsoum (RB), from Cairo University in Egypt, discusses his recent review with Dr. Helbert Rondon (eAJKD), eAJKD Contributor.

eAJKD:How did you become interested in parasitic kidney disease?

RB：Soon after I began practicing clinical nephrology in 1969, my colleagues and I at Cairo University and the Naval American Research Unit (NAMRU)-3 in Cairo encountered several cases of a full-blown nephrotic syndrome in patients with hepatosplenic schistosomiasis. This disease typically spares the urinary tract. We obtained kidney biopsies from these patients and found histologic lesions similar to those reported by Brazilian investigators. Our group published several papers on glomerulonephritis in hepatosplenic schistosomiasis, particularly when associated with salmonellosis—a well-known co-morbidity. We later identified a pathogenetic link, established a role of impaired hepatic macrophage function, and implicated Th2 cytokines, particularly IL-10, in the disease process. Finally, we put together a histopathologic classification system of the different glomerular lesions in hepatosplenic schistosomiasis, and correlated them with clinical features and prognosis.

eAJKD:Why is this topic important? Can you comment on the importance of these diseases for physicians in Western countries where they are not frequently seen in clinical practice?

RB：According to the World Health Organization (WHO), one in four individuals living on our planet is infected with one or more parasites. Literally, hundreds of millions are infected, and millions die every year as a direct result of those infections. The prevalence of acute kidney injury (AKI) due to malaria is 10 fold that of all other causes of AKI. Eighty percent of chronic kidney disease (CKD) patients in the world live in areas endemic for parasitic disease with these infections the cause of their kidney disease in an appreciable, yet imprecisely identified, frequency. Colleagues in the West are not commonly aware of the magnitude of this health problem, largely because of the containment of parasitic diseases in Africa, India, South-East Asia, and Central and South America. However, more and more parasitic diseases are being seen in the industrialized world owing to immigration of infected patients and vectors and exposure of Western populations through tourism and ex-partite appointments. Furthermore, the impact of parasitic infection has been seriously magnified by the growing immunocompromised populations including those with HIV infection, malignancy, and immunosuppression for organ transplantation. While many parasites share this scenario, my article is focused only on those which seem to cause the highest morbidity, both in endemic areas and in Western communities.

eAJKD:您能简要描述我们对寄生肾病的理解中的里程碑吗？

RB：I have conventionally classified the evolution of our knowledge in this area into 4 stages: a) Ancient scripts, drawings, and embossments dating to about 2500 BCE in Egyptian, Sumerian, Assyrian, Indian, Nok, and other civilizations, followed many centuries later by documentation of the clinical syndromes associated with relevant parasitic diseases by Greek, Roman, and Byzantine philosophers; b) discovery of the causative agents and life cycles during the 19th century; c) discovery of the kidney manifestations of such infections during the 20th century; and d) appreciation of the impact of co-infection with multiple parasites, bacteria, and viruses around the turn of the millennium.

eAJKD:Can you comment on the epidemiology of parasitic kidney disease in Africa and Asia? Is parasitic kidney disease identified as an important cause of CKD or end-stage renal disease in these geographical areas?

RB：没有统计数据可以合理的准确性回答这个问题。但是，有一些相关数据可以帮助我们。据估计，1％的恶性疟疾患者出现AKI。获取有关此类疟疾发病率的WHO数据，该寄生虫将占每百万人口的1200例，主要是在非洲，印度，中国和东亚。埃及肾脏病学会的注册表数据40年前将血吸虫病归咎于29％接受常规透析治疗的患者中CKD的原因。随着大规模治疗计划的实施，根据对同一注册表的最新评论（2010年），这一比例下降到8％。利什曼病的数据甚至更精确。根据世卫组织的说法，只有三分之一的案件被正式报告，与CKD的关联文件较少。丝状肾病的数据仍然较弱。

eAJKD:我们如何建立因果关系之间的寄生在fection and a specific pattern of kidney disease (i.e., glomerulonephritis) beyond a simple temporal relationship?

RB：有三组数据建立了这种关系：a）动物模型，其中特定的肾小球病变可以通过实验感染以剂量依赖性方式诱导（例如，血吸虫病）；b）通过免疫荧光或原位杂交证明早期肾小球沉积物中的寄生虫抗原（所有4个寄生虫都涉及文章）；c）CKD平行聚类在各自寄生虫感染率最高的区域，肾脏疾病平行消除寄生虫计划的显着降低（例如，疟疾，血吸虫病）。

To view the文章(freely available),please visitajkd.org。