Renal Involvement in Leprosy in the Multidrug Therapy Era: Current Evidence and Clinical Monitoring

Purpose of Review Leprosy remains a contemporary tropical-medicine challenge in which systemic complications may be overlooked when follow-up is centered on skin lesions, peripheral nerves, and completion of multidrug therapy (MDT). This review synthesizes historical and MDT-era evidence on renal involvement in leprosy and reframes kidney assessment as a practical complication-monitoring issue for infectious-disease care. Recent Findings Classical clinicopathologic studies established that leprosy may be associated with glomerular disease, tubulointerstitial injury, and amyloid A amyloidosis, particularly in multibacillary or lepromatous disease with recurrent erythema nodosum leprosum (ENL). In the MDT era, severe nephropathy appears less dominant, whereas renal involvement may be expressed through milder, dynamic, and context-dependent abnormalities, including albuminuria or proteinuria, microscopic hematuria, mild creatinine elevation, estimated glomerular filtration rate decline, and investigational inflammatory or endothelial signals such as MCP-1 and VCAM-1. These findings should be interpreted probabilistically, because bacillary burden, reactional inflammation, delayed diagnosis, hypertension, nephrotoxic exposure, dehydration, sepsis, and rifampicin-associated acute kidney injury may coexist. Summary Renal monitoring in leprosy should prioritize risk-enriched patients, including those with multibacillary disease, ENL or recurrent reactions, delayed diagnosis, abnormal urinalysis, hypertension, nephrotoxic exposure, or rising creatinine. Conventional assessment with serum creatinine, estimated glomerular filtration rate, urinalysis with microscopy, and albuminuria or proteinuria testing may help identify patients who require repeat evaluation, broader differential work-up, or nephrology referral. The proposed approach is a pragmatic synthesis for risk-based clinical reasoning, not a validated guideline or prognostic score.