Renal involvement in the course of arbovirus infections, a nephrological challenge

Abstract

Arboviruses are a group of different families and genera of viruses transmitted by hematophagous arthropods, such as mosquitoes, ticks, and fleas. The main vector of dengue and chikungunya is Aedes aegypti. Dengue is considered one of the main subtropical diseases due to its frequency, distribution, incidence, and the number of deaths it causes. It presents in epidemic form and causes clinical manifestations such as fever, headache, rashes, body aches, myalgia, and joint problems such as arthralgia. Renal complications include chronic kidney disease, considered a factor associated with greater severity of dengue; acute kidney failure (which is rare), reversible or irreversible chronic glomerulonephritis, and amyloidosis. In cases of chikungunya, it can cause acute kidney injury and is associated with increased mortality due to rhabdomyolysis, acute interstitial nephritis, thrombotic microangiopathy, and a history of kidney disease, focal segmental glomerulosclerosis, crescentic glomerulonephritis, pauci-immune vasculitis, PLA2R-positive membranous nephropathy, collapsing glomerulosclerosis, and nephritic syndrome. Renal involvement in Zika has not been thoroughly studied; the virus can invade and replicate in glomerular cells, causing interstitial nephritis, glomerulonephritis, tubular proteinosis, and acute kidney failure. In endemic areas, continuous monitoring of the vector and kidney function should be performed in all infected patients, including transplant recipients. There is no specific treatment available for these viral infections, so supportive care, including dialysis in cases of severe kidney damage, remains the mainstay of treatment.