Visceral leishmaniasis involving the kidney by direct infection and immune-mediated glomerulonephritis

Leishmania are protozoan parasites that can infect the renal parenchyma and cause glomerular disease, in particular membranoproliferative glomerulonephritis, by immune-mediated mechanisms. Here, we present the case of a 50-year-old patient with a history of HIV infection, recurrent visceral leishmaniasis, past hepatitis C and previous illicit drug abuse. The patient presented with acute on chronic kidney injury and progressive proteinuria. Renal biopsy revealed interstitial nephritis and infection-related glomerulonephritis (IRGN) without membranoproliferative pattern. Leishmania parasites were detectable in interstitial macrophages, tubular epithelial cells and glomerular macrophages and confirmed by rabbit-anti-Leishmania- or rabbit-anti-CD1a-antibodies. Infected macrophages showed an M2-like phenotype. While interstitial nephritis and glomerular disease have been described in a few cases of visceral leishmaniasis, before, our case is remarkable for the presence of leishmanial amastigotes in glomerular macrophages and IRGN at the same time, adding to the spectrum of renal manifestations associated with leishmanial infection.