Abstract: FR-PO965
Spectrum of Kidney Pathology in Patients with Syphilis
Session Information
- Pathology and Lab Medicine - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1800 Pathology and Lab Medicine
Authors
- Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
- Larsen, Christopher Patrick, Arkana Laboratories, Little Rock, Arkansas, United States
Background
Syphilis has been associated with multiple kidney diseases, primarily studied within small series. A large cohort of patients with active syphilis who underwent kidney biopsy were examined to evaluate the histopathologic spectrum and clinicopathologic features of disease.
Methods
Patients with syphilis who underwent a native kidney biopsy were identified from the renal pathology archives at Arkana Laboratories from 2006-2024. Patients were identified through a listed clinical history of syphilis in the medical record and/or positive laboratory testing for RPR or anti-treponemal antibodies. Patients with a remote or treated syphilitic infection were excluded.
Results
A total of 111 patients with syphilis who underwent kidney biopsy were identified. The mean age was 42.0 ±14.5 years and there was male predominance (86.5%). The majority of patients presented with acute kidney injury with a mean serum creatinine of 4.4 ± 3.8 mg/dL. Co-infections were common, with HIV in 53 (47.7%), HBV in 9 (8.1%), and HCV in 9 (8.1%).
The most common disease states, in descending order, included membranous nephropathy (MN) (n=29), HIV-associated diseases (n=21), acute interstitial nephritis (AIN, n=11), acute tubular injury (n=11), infection-associated glomerulonephritis (n=9), and IgA nephropathy (n=8). The remaining patients had various diagnoses unlikely to be associated with syphilitic infection, such as diabetic glomerulosclerosis (n=12) and arterionephrosclerosis (n=7), among others.
Of 29 patients with MN (26.1%), 2 were PLA2R+, 2 were EXT+, and the remaining were PLA2R negative of unknown type. Staining for multiple immune reactants was common in MN cases with IgA staining in 24.1%, IgM in 34.5%, C3 in 89.7%, C1q in 44.8%, and 10.3% were 'full-house'. Of 21 patients with HIV-associated pathology (18.9%), 17 had collapsing glomerulopathy (HIVAN) and 7 had mesangial immune complex deposition (HIVICK). Of 11 patients with AIN, 5 were plasma cell rich, 1 was neutrophil rich, and the remaining had mixed infiltrates. Three of 8 patients with IgA nephropathy were secondary to liver disease related to viral hepatitis.
Conclusion
The most common kidney biopsy diagnosis seen in patients with syphilis was membranous glomerulopathy. Disease associated with co-infections, particularly HIV and viral hepatitis, were also common in this setting.