Systemic infections and the kidney

Abstract 

Systemic infections may result in renal damage by a wide variety of mechanisms, including pre- and post-renal, as well as causing intrinsic renal disease. Glomerular lesions are most often immunologically mediated and often accompanied by deposition of immunoglobulins and complement. Tubulo-interstitial disease is most commonly caused by toxic damage or by direct infection by the pathogen, though in the case of some viral infections, direct invasion of glomerular cells is implicated (such as HIV or parvovirus in podocytes). Chronic infections (e.g. hepatitis viruses, schistosomiasis) can cause particularly intractable disease, but recent reviews have cast doubt on the concept of chronic malarial nephropathy.

Complications of treatment are a common cause of renal impairment in systemic infections. These may be idiosyncratic, such as allergic interstitial nephritis, or predictable consequences, such as tubular toxicity (aminoglycosides, amphotericin) or precipitation of antibiotic agents, such as aciclovir, protease inhibitors, or even (rarely) ciprofloxacin.

Keywords: complement, glomerulonephritis, infective endocarditis, interstitial nephritis