Glomerulopathies found in HIV+ patients. Case report of a public hospital in Buenos Aires city

Abstract

The purpose of this study was to study the renal pathological findings and the evolution of HIV-(+) patiens with proteinuria and / or hematuria with or without impaired renal function. We performed a retrospective analysis of patients with acquired immune deficiency syndrome (AIDS) HIV-1 (+), following by external nephrology clinic.
We identified 6 patients (p), all Argentine and white. Kidney disease was not the initial presentation of AIDS in any of our patients. The clinical manifestations at first consultation were as follows: all patients had microscopic hematuria (p 1 with gross hematuria) and proteinuria, nephrotic range in 2 p, two p. with renal failure, one p. had arterial hypertension (HTA). The pathology reports of renal biopsies were heterogeneous: glomerulonephritis and endo extracapilar: 1p; IgA nephropathy: 1p; mesangial IgM glomerulonephritis: 1p: glomeruloesclerosis focal segmental classical 1p; membranous nephropathy: 1p; Membranoproliferative glomerulonephritis type III 1p. One of the patients who had presented impaired renal function since the beginning, evolved with ESRD and dialysis requirement, the other 5p evolved with stable renal function with persistent proteinuria values and refractory to conventional treatments.
By the time of the diagnosis of kidney disease, all patients had consolidated HAART treatment, and tolerated without renal toxicity. Two patients had CD4 viral load (+), p 3 showed concomitant counts of < 200 and had infectious diseases, 2 of them with HCV (+) and syphilis, 1 with HCV (+) and anti-HBc (+) with HBsAg ( -). A single patient received immune suppressive treatment (steroids), 3 were treated with inhibitors of angiotensin II.
The criteria that were used for performing the renal biopsy were highly predictive of glomerulonephritis. We were not able to identify a glomerulopathy prevalent, although the predominant pathogenic mechanism similar to that caused by immunocomplexes, and the histological pattern of glomerulopathies was very variable. As follow-up was short term, we could not reach conclusions regarding the prognosis of neuropathy.

Como citar este artículo:

Petrolito J, Di Tullio D, Schiavelli R, Chanta G, Kidd S, Mera V, Kozima S, Larrañaga N. [Glomerulopathies found in HIV+ patients. Case report of a public hospital in Buenos Aires city]. Rev Nefrol Dial Traspl. 2009;29(3):115-23.