Authors
Xuan Long, Weipeng Lin, Donghua Liu
Published in
American journal of kidney diseases : the official journal of the National Kidney Foundation. Oct 31, 2026. Epub Oct 31, 2026.
Abstract
Syphilis-associated kidney disease is rare and most commonly occurs in active syphilis. This systematic review summarizes the clinicopathologic spectrum, treatment, and outcomes of syphilis-associated kidney disease.
Systematic review of published case reports and case series.
Cases with serologically confirmed syphilis and kidney disease attributed to syphilis, reported between January 1990 and December 2025.
PubMed and Web of Science were searched for case reports and case series with extractable individual-level data. Reports of congenital syphilis, conference abstracts, articles without full-text access, and cases lacking individual patient data were excluded.
Case-level data were extracted for demographics, the clinical presentation of syphilis, HIV status, serology findings, kidney manifestations including biopsy findings, treatment, kidney outcomes, and follow-up.
Data were synthesized descriptively. Continuous variables were summarized as median and interquartile range, categorical variables as counts and percentages. Between-group and paired comparisons implemented using nonparametric or categorical tests, as appropriate.
99 cases from 78 publications were identified and included. Median age was 34 years, and 75% of patients were male. The median non-treponemal titer category was 1:256. Nephrotic syndrome occurred in 81% of patients and acute kidney injury in 32%. Membranous nephropathy was the most common biopsy diagnosis (79%), and a full-house immunofluorescence pattern was reported in 26% of biopsied cases. All patients received anti-syphilitic therapy, and 11% also received immunosuppressive therapy. Among patients with available outcome data, complete remission occurred in 75% and partial remission in 23%, with a median follow-up of 4 weeks. Kidney parameters generally improved after anti-syphilitic treatment.
Evidence was derived mainly from case reports and case series, with potential publication, reporting, language, and database-selection bias. Detailed histopathology and treatment duration were inconsistently reported.
Syphilis-associated kidney disease most commonly presents as membranous nephropathy with nephrotic syndrome and usually improves after anti-syphilitic therapy.
Registered at PROSPERO with identification number CRD420261322314.
PMID:
42966598
Bibliographic data and abstract were imported from PubMed on 01 Nov 2026.
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