Parasitic Kidney Disease: Milestones in the Evolution of Our Knowledge Rashad S. Barsoum, MD, FRCP, FRCPE  American Journal of Kidney Diseases  Volume 61, Issue 3, Pages 501-513 (March 2013) DOI: 10.1053/j.ajkd.2012.09.025 Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Reported parasitic kidney diseases. a, Usually with asplenia; b, acute kidney injury reported mainly in immunocompromised patients; c, associated with hydatid disease; d, nephrotic syndrome often associated with the development of amyloidosis; e, progressive chronic kidney disease (CKD) is usually associated with significant liver injury; f, asymptomatic proteinuria may be masked by associated chyluria. Data from Barsoum.2 American Journal of Kidney Diseases 2013 61, 501-513DOI: (10.1053/j.ajkd.2012.09.025) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Timeline of the key discoveries in the story of parasitic kidney diseases. Abbreviations: EBV, Epstein-Barr virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NS, nephrotic syndrome. American Journal of Kidney Diseases 2013 61, 501-513DOI: (10.1053/j.ajkd.2012.09.025) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Glomerulus and adjacent structures in a patient with class VI schistosomal glomerulopathy (associated with cryoglobulinemic chronic hepatitis C viral infection). Note the combination of almost the full spectrum of Schistosoma-associated lesions in the same glomerulus (Masson trichrome stain; original magnification, ×500). m, mesangial expansion with focal cellular proliferation and remnants of apoptotic cells (dusty particles). f, focal segmental glomerulosclerosis nodules (negative for Congo-Red stain–not shown). a, amyloid deposits (positive for Congo-Red stain and confirmed by apple-green birefringence under polarized light–not shown). t, intracapillary thrombi containing cryoglobulin (positively staining with anti-immunoglobulin M antibodies–not shown). i, interstitial fibrosis and tubular atrophy. Reproduced from Barsoum27 with permission of Macmillan Publishers Ltd. American Journal of Kidney Diseases 2013 61, 501-513DOI: (10.1053/j.ajkd.2012.09.025) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Typical glomerular lesion attributed to quartan malaria. (Left) Mesangiocapillary: membranoproliferative lesion with focal basement membrane thickening (hematoxylin and eosin stain). (Right) Silver stain shows basement membrane thickening with intramembranous “lacunae” of immune deposits. Reproduced from Barsoum2 with permission of the European Renal Association–European Dialysis and Transplant Association. American Journal of Kidney Diseases 2013 61, 501-513DOI: (10.1053/j.ajkd.2012.09.025) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 5 Classic stages of the immune response to schistosomiasis, applicable to most parasitic infections with some differences in the details. Abbreviations: Ig, immunoglobulin; IL, interleukin; Sm-PEPCK, Schistosoma mansoni phosphoenolpyruvate carboxykinase egg antigen; TNF, tumor necrosis factor. Reproduced from Barsoum et al74 with permission of Lippincott Williams & Wilkins. American Journal of Kidney Diseases 2013 61, 501-513DOI: (10.1053/j.ajkd.2012.09.025) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions