Falciparum malaria in naturally infected human patients: X . Ultrastructural pathological alterations of renal glomeruli

The ultrastructural pathological alteration of the renal glomeruli is described in nine patients with acute Plasmodium falciparum infection. Glomeruli were large and hypercellular with various types of blood cells in their capillary lumena. These were occasionally occluded with enlarged endothelial cells. Epithelial cells, or podocytes, were hypertrophied with extensively diffused fool processes fusion and numerous villous transformation, or appeared aedematous filling the urinary space. The glomeruli basement membrane was irregular in thickness or focally missing. Mesangial cells were undergoing proliferation and contained electron-dense deposits. Subendothelial "hump"-like deposits, similar to those previously described in immune complex nephritis, were detected in most cases; but the largest amount was found in three youngest patients in whom parasitaemia levels were the highest. This study showed that the kidney may become the target damage mediated by immuno-pathologic mechanism, and the developed lesions may correspond, for certain extent, to membranoproliferative glomerulonephritis with abnormal deposits, during the acute infection with falciparum malaria. The amount and density of the immune complex deposit could be correlated with the degree of parasitaemia and, in return, with the degree of glomerular immunopathological alterations