[Henoch-Schönlein purpura nephritis in a patient infected with the human immunodeficiency virus].
There are various forms of renal lesions in patients with human immunodeficiency virus(HIV), however reported cases of immune-complex glomerulonephritis are scarce. Here we describe an HIV-positive patient with Henoch-Schönlein purpura nephritis(HSPN), which presented as nephrotic syndrome. In addition to therapy combined with glucocorticosteroid and inhibition of the renin-angiotesin system(RAS), plasmapheresis and antiretroviral therapy produced a favorable outcome. A 26-year-old HIV positive man was admitted for purpura on both lower limbs. Despite glucocorticosteroid treatment, purpura recurred and urinary protein increased to 5-10 g daily. HSPN was diagnosed based on the skin and renal biopsies. During 2 months of treatment with combined glucocorticosteroid and RAS inhibition, nephrotic syndrome persisted. He received double filtration plasmapheresis(DFPP). Soon after, urine protein decreased to 2-3 g daily and macrohematuria decreased. The second renal biopsy showed a decrease in IgA deposition and improvement of acute inflammatory changes. In addition, highly active antiretroviral therapy was started to reduce the high viral load. After 3 weeks, HIV-1-RNA rapidly decreased and urine protein decreased to 1 g daily. After a year, urinary protein was negative, but mild microhematuria persisted. We speculate that the refractory nephrotic syndrome in this patient might be associated with the abnormal immunological condition due to HIV infection.
Hidaka
Hiromi
H
Department of Nephrology, Tokyo Medical University, Tokyo, Japan.
Okada
Tomonari
T
Matsumoto
Hiroshi
H
Yoshino
Maki
M
Nagaoka
Yume
Y
Takeguchi
Fumihiro
F
Iwasawa
Hideaki
H
Tomaru
Ryou
R
Wada
Toshikazu
T
Shimizu
Tohru
T
Ohtani
Masako
M
Yamanaka
Kou
K
Fukutake
Katsuyuki
K
Nakao
Toshiyuki
T
D016263:AIDS-Associated Nephropathy / Q000276:immunology; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D011695:IgA Vasculitis / Q000209:etiology* / Q000628:therapy; D008297:Male; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000628:therapy; D010956:Plasmapheresis; D011239:Prednisolone / Q000008:administration & dosage
D000893:Anti-Inflammatory Agents; D011239:Prednisolone