Nephrol Dial Transplant (1996) 11: 2074-2076 Case Report Nephrology Dialysis Transplantation Reversible nephrotic syndrome due to mesangiocapillary glomerulonephritis secondary to hepatic hydatid disease A. Covic 1 ,1. Mititiuc 1 , L. Caruntu 1 and D. J. A. Goldsmith 2 'University Hospital of Lasi, Lasi, Romania, and 2 Royal Sussex County Hospital, Brighton, UK Key words: hydatid disease; mesangiocapillary glom- erulonephritis; nephrotic syndrome Introduction Hydatid disease (echinococcosis) is a cyclozoonotic infection with the dog tapeworm Echinococcus gran- ulosis, more commonly seen in men than in women. The worm is endemic to many parts of the world, including Europe, Asia and the Americas. The usual life-cycle is between dogs and sheep, with humans infrequently accidental hosts. Rarer primary hosts are foxes, horses, wolves and jackals. The life-cycle is shown in Figure 1. There are no specific local or general signs and symptoms, while the distribution and manifestations of hydatidosis are ubiquitous and protean. Liver and lung are the two commonest organs involved (one or both in 90% of cases), but the kidney is very rarely affected primarily (2% in 1802 cases in the Australasian Hydatid Register [1]). Usually symptoms arise from the expanding presence of the cysts inside organs, or after cysts rupture. Systemic ill-effects are rare. Diagnosis is made by history of exposure, by radiolo- Definitive Host: Intermediate Host: DOG FOX WOLF Aduttwormln intntlne <=INFECTED OFFAL<= EGGS (FAECES) u PIGS RODENTS SHEEP CATTLE Hyd»ad cy»t» vtacen MAN cy»t» In Itvw, bjng Accidental Intermediate Host : Fig. 1. Life cycle of Echinococcus grunulosus. Correspondence and offprint requests to: Dr David J. A. Goldsmith, Consultant Nephrologist, Trafford Department of Renal Medicine, Royal Sussex County Hospital, Brighton BN2 5BE, UK. gical and ultrasonographic cyst detection, and by serology [1]. Secondary renal involvement as a response to the presence of Echinococcus in other parts of the body is exceptionally unusual, with sporadic reporting of glomerular lesions (IgA nephropathy [2], membran- ous glomerulopathy [3] and mesangiocapillary glomerulonephritis [4]). We report a unique case of a female who presented with nephrotic syndrome due mesangiocapillary glomerulonephritis (MG) with a large hepatic hydatid cyst. Proteinuria was abolished by surgical cyst removal, but later returned with a relapse of hydatid disease, a renal biopsy again con- firming MG. Definitive treatment for hydatid disease abolished all proteinuria and restored the patient to sustained good health. Case report A 67-year-old woman complained of ankle swelling of recent onset in January 1995. This worsened despite initial therapy with digitalis and diuretics. She rapidly became severely hypertensive, and presented to hospital with hypertensive encephalopathy and gross oedema in February 1995. On admission to hospital she had anasarca, though without significant pleural or pericardial effusions, or ascites. Blood pressure was 220/120 mmHg. Her liver was grossly enlarged, firm and tender. The spleen was not enlarged. She was afebrile. Her urine was frothy, tested positive to blood and protein on dipsticking, and contained dysmorphic red cells and proteinaceous casts. She was excreting 24 g of urinary protein per 24 h (non-selective; albu- min-globulin ratio of 1.32). Renal function was abnormal (urea 9 mmol/1; creatinine 180 umol/1). Haemoglobin was 9.6 g/1 with a normochromic, normocytic blood film and no evidence of red cell fragmentation. Serum iron was normal. The white count was elevated at 28 000, with a neutrophil leu- koytosis but no eosinophilia. Platelets were normal at 180000. The ESR was 160 mm in the first hour. Liver function tests were normal. Autoantibody screening was negative (including ANA and ANCA), and serum © 1996 European Renal Association-European Dialysis and Transplant Association Downloaded from https://academic.oup.com/ndt/article/11/10/2074/1815067 by guest on 03 January 2024