Figure 634

Histologic lesions in a patient with progressive Schistosoma mansoni glomerulopathy. A, Mesangial proliferative glomerulonephritis. (Hematoxylin-eosin stain X 150.) B, Exudative glomerulonephritis, often encountered with concomitant Salmonella paratyphi A infection [9]. (Hematoxylin-eosin stain X 150.) C, Mesangial proliferation with areas of mesangiocapil-lary changes. (Hematoxylin-eosin stain X 150.) D, Focal and segmental glomerulosclerosis. (Masson trichrome stain X 150.) The two lesions in panels C and D are associated with advanced hepatic fibrosis, impaired macrophage function, and predominant immunoglobulin A mesangial deposits [7,55]. The lesions shown are categorized, respectively, as classes I to IV schistosomal glomerulopathy according to the classification system of the African Association of Nephrology [54].

Pathogenesis of S. mansoni glomerulotherapy

Adult worms in the portal vein

Egg granulomata in the portal tracts

Egg granulomata in the colonic mucosa w

Autoimmunity

Antigens

Mucosal breach

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