The disease passes through three distinct phases which are: occult
glomerulopathy, overt glomerulopathy and end-stage glomerulopathy.
- Occult glomerulopathy is usually silent. Asymptomatic proteinuria is
an early expression of the disease which was reported in 20% of
Egyptian patients and 26% of Brazilian patients with active
schistosoma mansoni infection. Patients in this phase have less hepatic
and more intestinal schistosomal disease. Histopathologic examination
of kidney biopsy by light microscopy will show either no change or
mild mesangioproliferative lesion, with little or no expansion of
mesangial matrix but with occasional focal thickening of the basement
membrane. Immunofluorescence shows mostly mesangial deposits of
IgM- containing immune complexes, schistosomal antigens and
complement C3. - Overt glomerulopathy nephrotic syndrome with or without renal
impairment is the commonest presentation in this phase. Hypertension
is noticed in 30-50 percent of patients. Less commonly, patients may
present with non-nephrotic proteinuria.
Patients in this phase always have hepatosplenic disease. The liver
is firm and shrunken. The spleen is enlarged. Ascites may be present and
oesophageal varices may be detected. Histopathologic examination of a
kidney biopsy shows focal segmental glomerulosclerosis or mesangio-
capillary glomerulonephritis (Fig. 3.10).- End-stage glomerulopathy: Patients usually present with uraemic
manifestation in association with hepatosplenic schistosomiasis.
Histopathologic examination of kidney biopsy may show
glomerulosclerosis, interstitial fibrosis and tubular atrophy.