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Case 138


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35-year-old male patient attended in a hospital complaining of fatigue, weight loss and diarrhea for 8 months. On physical examination, he presents ascites and edema of lower limbs. There are not jaundice, rash, gynecomastia and telangiectasias. Previous history of splenectomy (hepatosplenic schistosomiasis) 11 years ago. Laboratory tests results: Albumin 2.2 g/dL; Total Cholesterol 429 mg/dL; AST 70 IU/L; ALT 71 IU/L; ALP 247 IU/L; GGT 229 IU/l. Serology positive for HBsAg, Anti-HBc IgG, Anti-HBE and Anti HAV IgG. Proteinuria (5,94g/24 hr); Urinalysis: hematuria (+ +/4 +). O&P negative.

Based on clinical history and images from microscopy, we can affirm that this patient has clinical signs of, except:

a) Nephrotic syndrome


b) Hepatic insufficiency


c) Portal hypertension


d) Systemic congestion



- The Brazil is an endemic country for hepatitis B and schistosomiasis.

- Portal hypertension can rise from mechanical and functional changes in the circulation of the hepatic portal venous system, which can be caused either by schistosomiasis or by hepatitis B.

- Carriers of the hepatosplenic form of schistosomiasis can develop glomerulopathy, which the diagnosis is usually late and has a bad prognosis.

- Renal injuries are more frequent and evident in HBsAg carriers.


- Chan TM. Hepatitis B and Renal Disease. Curr Hepatitis Rep, April 14, 2010: 99-105.

- Godoy P. Sistema urinário. In: Brasileiro-Filho G, editor. Bogliolo Patologia. Belo Horizonte: Guanabara- Koogan, 2006. p. 448-553

- Lai NK. Hepatites Related-Renal Disease. Future Virology, 2011, 6(11):1361-1376.

- Nussenzveig I, Brito T, Carneiro CRW, Silva AMG. Human Schistosoma mansoni-associated glomerulopathy in Brazil. Nephrol Dial Transplant, 2002: 4-7.

- Ranalli TV, et al. Liver schistosomiasis: an unexpected finding in hepatitis B virus-related hepatitis. International Journal of Infectious Diseases, 2008: e67-e70.

- Velthuysen MIF, Florquin S. Glomerulopathy Associated with Parasitic Infections. Clinical Microbiology Reviews, Jan 2000: 55-66.

- Eng-Kion T. Epidemiology, transmission, and prevention of hepatitis B virus infection. Walthman (MA): UpToDate; 2013. Available at:


Bárbara de Queiroz e Bragaglia, 5th year medical student at UFMG School of Medicine

E-mail: barbaraqueiroz[at]

Daniele Araújo Pires, 5th year medical student at UFMG School of Medicine

E-mail: dani_arp[at]

Eduardo Gomes Campanati, 6th year medical student at UFMG School of Medicine

E-mail: duducampa[at]


Prof Luciana Diniz Silva, gastroenterologist, professor of the Department of Clinical Medicine at UFMG School of Medicine

E-mail: lucianadinizsilva[at]


Glauber Eliazar, Luanna Monteiro, Marina Leão, Cinthia Barra, Prof Viviane Parisotto, Hercules Riani

Translated by

Hercules Hermes Riani Martins Silva, 5th year medical student at UFMG School of Medicine

E-mail: herculesriani[at]


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