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Discontinuation of antiretroviral therapy causing progression to end-stage renal disease in an HIV patient diagnosed with immune complex 'lupus-like' glomerulonephritis.

Shah S, Weber-Shrikant E, Panesar M - Clin Kidney J (2012)

Bottom Line: Immune complex 'lupus-like glomerulonephritis' is a type of renal injury seen infrequently in human immunodeficiency virus (HIV) patients and very little is known about the clinical course and treatment.Treatment options are limited but antiretroviral therapy and steroids have been tried with limited success.We report a case of a 21-year-old HIV-positive African American male with lupus-like glomerulonephritis who progressed to end-stage renal disease upon discontinuation of highly active antiretroviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Nephrology, State University of New York, Buffalo, NY, USA.

ABSTRACT
Immune complex 'lupus-like glomerulonephritis' is a type of renal injury seen infrequently in human immunodeficiency virus (HIV) patients and very little is known about the clinical course and treatment. Treatment options are limited but antiretroviral therapy and steroids have been tried with limited success. We report a case of a 21-year-old HIV-positive African American male with lupus-like glomerulonephritis who progressed to end-stage renal disease upon discontinuation of highly active antiretroviral therapy. This case illustrates the importance of antiretroviral therapy as an important treatment modality for immune complex lupus-like glomerulonephritis in HIV patients.

No MeSH data available.


Related in: MedlinePlus

Renal biopsy (2010). (A) Immunofluorescence microscopy shows intense global and granular glomerular IgG deposits along capillary walls and in the mesangium (×200). (B) Glomerulus with mild segmental hypercellularity (hematoxylin and eosin stain ×200). (C) Cystic tubular dilation with scalloped edges and luminal protein casts, tubular atrophy, interstitial fibrosis and interstitial chronic inflammation (hematoxylin and eosin stain ×200).
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fig1: Renal biopsy (2010). (A) Immunofluorescence microscopy shows intense global and granular glomerular IgG deposits along capillary walls and in the mesangium (×200). (B) Glomerulus with mild segmental hypercellularity (hematoxylin and eosin stain ×200). (C) Cystic tubular dilation with scalloped edges and luminal protein casts, tubular atrophy, interstitial fibrosis and interstitial chronic inflammation (hematoxylin and eosin stain ×200).

Mentions: The following differential diagnoses were considered: (i) HIV nephropathy, (ii) rapidly progressive glomerulonephritis, (iii) acute tubular injury due to nephrotoxic HIV medications or volume depletion and (iv) lupus-like glomerulonephritis. The patient underwent percutaneous kidney biopsy, which was diagnostic of lupus-like proliferative glomerulonephritis (Figure 1).


Discontinuation of antiretroviral therapy causing progression to end-stage renal disease in an HIV patient diagnosed with immune complex 'lupus-like' glomerulonephritis.

Shah S, Weber-Shrikant E, Panesar M - Clin Kidney J (2012)

Renal biopsy (2010). (A) Immunofluorescence microscopy shows intense global and granular glomerular IgG deposits along capillary walls and in the mesangium (×200). (B) Glomerulus with mild segmental hypercellularity (hematoxylin and eosin stain ×200). (C) Cystic tubular dilation with scalloped edges and luminal protein casts, tubular atrophy, interstitial fibrosis and interstitial chronic inflammation (hematoxylin and eosin stain ×200).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400503&req=5

fig1: Renal biopsy (2010). (A) Immunofluorescence microscopy shows intense global and granular glomerular IgG deposits along capillary walls and in the mesangium (×200). (B) Glomerulus with mild segmental hypercellularity (hematoxylin and eosin stain ×200). (C) Cystic tubular dilation with scalloped edges and luminal protein casts, tubular atrophy, interstitial fibrosis and interstitial chronic inflammation (hematoxylin and eosin stain ×200).
Mentions: The following differential diagnoses were considered: (i) HIV nephropathy, (ii) rapidly progressive glomerulonephritis, (iii) acute tubular injury due to nephrotoxic HIV medications or volume depletion and (iv) lupus-like glomerulonephritis. The patient underwent percutaneous kidney biopsy, which was diagnostic of lupus-like proliferative glomerulonephritis (Figure 1).

Bottom Line: Immune complex 'lupus-like glomerulonephritis' is a type of renal injury seen infrequently in human immunodeficiency virus (HIV) patients and very little is known about the clinical course and treatment.Treatment options are limited but antiretroviral therapy and steroids have been tried with limited success.We report a case of a 21-year-old HIV-positive African American male with lupus-like glomerulonephritis who progressed to end-stage renal disease upon discontinuation of highly active antiretroviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Nephrology, State University of New York, Buffalo, NY, USA.

ABSTRACT
Immune complex 'lupus-like glomerulonephritis' is a type of renal injury seen infrequently in human immunodeficiency virus (HIV) patients and very little is known about the clinical course and treatment. Treatment options are limited but antiretroviral therapy and steroids have been tried with limited success. We report a case of a 21-year-old HIV-positive African American male with lupus-like glomerulonephritis who progressed to end-stage renal disease upon discontinuation of highly active antiretroviral therapy. This case illustrates the importance of antiretroviral therapy as an important treatment modality for immune complex lupus-like glomerulonephritis in HIV patients.

No MeSH data available.


Related in: MedlinePlus