But urinary schistosomiasis can have devastating impact on the urinary tract and indeed the whole kidney which, if not detected early and prompt interventions instituted, could be fatal.2,8 This, notwithstanding,
in most endemic countries, the extent of renal complications of schistosomiasis in children has not been fully established.2 It is believed to be higher than generally appreciated.9 The most prominent and important pathology in schistosomiasis results from the host response to schistosomal eggs retained in tissues.2,8,9 Following infection, the adult worms (male: female pairings) inhabit the venules of the urinary tract from where the females release Selleckchem Dabrafenib large quantities of eggs which may remain embedded in the tissues, embolise to other organs, or pass into the urine.8 Eggs trapped in selleck inhibitor tissues stimulate a strong granulomatous reaction which heals by fibrosis.2,8,9 On the urinary system, schistosomal nephropathy typically presents as granulomatous inflammation of the distal third of both ureters, the urinary bladder and the urethra and may be followed by calcification resulting in hydroureters, hydronephrosis, and bladder neck obstruction.2,,8,9 In the bladder, collections of fine mucosal tubercles called sandy
patches may develop as well as granulomas of various sizes (sessile or pedunculated).2 Persistent bladder schistosomiasis may be linked to squamous cell carcinoma of the bladder in adulthood.2,3 Besides its effect on the urinary tract,
schistosomal nephropathy may also present as immune-complex mediated glomerular disease typically as nephrotic syndrome.2,8–10 The chronic loss of blood that ensues from the persistent symptom of haematuria (overt or covert) may be a cause of iron deficiency anaemia and poor growth in children which may assume public health dimensions in heavily infected communities.2,11 The effect of urinary schistosomiasis is influenced by both the intensity of infection (judged by the eggs count) and the duration of infection.2,8,9 In this article, we present five of eight cases of urinary schistosomiasis that were seen in the paediatric nephrology/ urology units of Komfo Anokye Teaching Hospital (KATH) over a 2-year period. All five cases presented with obstructive uropathy, two of whom died from their disease; two underwent successful surgery; Vasopressin Receptor and one made a spontaneous “recovery”. The other three cases (not presented in this article) presented with acute glomerulonephritis-like syndrome and made complete recovery. Case 1 A 7-year old girl, EO, who had been admitted to the paediatric emergency unit of KATH with congestive heart failure (bibasal crepitations, cardiomegaly, tender hepatomegaly and peripheral oedema) and hypertension (BP 180/120mmHg) was subsequently found to have ova of Schistosoma haematobium in her urine. She had lived in Akosombo for greater part of her life.