Treatment of Perirenal Adenopathy Associated with Schistosoma Hematobium
The treatment of perirenal adenopathy associated with Schistosoma hematobium infection requires praziquantel as the antiparasitic agent of choice, administered in sufficient dosage and duration to eradicate the organism, with no indication for immunosuppressive agents in schistosomal nephropathy. 1, 2
Diagnostic Considerations
- Test for appropriate endemic coinfections (Salmonella, HBV, HCV, HIV) as targeted treatment of these may alter the aggressiveness of glomerulonephritis or other sequelae of schistosomiasis 1
- Consider kidney biopsy in patients with overt or progressive kidney disease (proteinuria >1 g/d, hypocomplementemia, hematuria, reduced GFR), but biopsy can be deferred in mild disease with empirical antiparasitic treatment 1
- Detection of parasitic antigens in glomeruli requires specialized laboratories, which should be considered when evaluating the utility of kidney biopsy 1
Treatment Protocol
- For Schistosoma hematobium infection, administer praziquantel 40 mg/kg orally as a single dose 2
- Ensure sufficient dosage and duration to completely eradicate the organism from the body 1
- No immunosuppressive agents are indicated in schistosomal nephropathy 1
Special Clinical Considerations
- In patients with perirenal adenopathy, monitor for development of urinary obstruction which can lead to hydronephrosis 3
- Evaluate patients with elevated serum creatinine and/or hematuria for bladder cancer and/or urinary obstruction, which are common complications of S. hematobium infection 1, 4
- Be aware that immune complexes containing schistosomal antigens may deposit in glomeruli, leading to various forms of glomerulonephritis including membranoproliferative glomerulonephritis 3
Monitoring and Follow-up
- Monitor patients with hepatic fibrosis from schistosomiasis for the development of kidney disease 1
- Be aware that serology may remain positive for years after successful treatment and cannot be used to assess treatment success 2
- Follow-up with imaging studies may be necessary to confirm resolution of perirenal adenopathy and associated urinary tract abnormalities 5
Potential Complications and Pitfalls
- Chronic schistosomiasis can lead to fibrosis and calcification of tissue-trapped ova in the lower urinary tract, causing obstruction, reflux, infection, and stone formation 3
- Interstitial nephritis may present with tubular dysfunction syndrome before progressing to end-stage renal disease 3
- Bladder lesions associated with S. hematobium are precancerous and require monitoring 3, 4
- While acute and early chronic lesions typically regress with antiparasitic treatment, chronic sequelae may be irreversible 3
Treatment Outcomes
- Most urinary tract abnormalities due to S. hematobium infection show marked reversibility one year after treatment with praziquantel, particularly in children 5
- Vesical calcifications may persist in some cases despite successful treatment 5
- End-stage renal disease resulting from long-standing infection may require dialysis and transplantation 3