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Infective agents affect the kidneys of children mainly through indirect mechanisms, i.e., via immunological reaction as part of an antigenic response. However, for children living in the tropics, there is also a direct mechanism of kidney injury which is less known by the medical community, simply because the direct mechanism is rarely seen in non-tropical countries. In some infectious diseases, both indirect and direct pathways are responsible in inducing two sets of morphologically separate renal lesions.
Six tropical infectious diseases affecting the kidney of children were reviewed in terms of their direct and/or indirect pathogenetic mechanism in inducing renal damage: Renal cryptococcosis to represent involvement of pure direct pathway; schistosomiasis and dengue fever as examples of dual direct and indirect pathways; and congenital syphilis, visceral leishmaniasis and chagas disease representing indirect pathway. Clinical manifestations, pathogenesis, renal pathology, and laboratory diagnostic methods for these tropical infectious diseases are reviewed and examples of each entity are illustrated.