title: [Henoch-Schönlein purpura nephritis in a patient infected with the human immunodeficiency virus].
abstract: 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.
authors.affiliation: Department of Nephrology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hidaka
authors.forename: Tomonari
authors.initials: T
authors.lastname: Okada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Maki
authors.initials: M
authors.lastname: Yoshino
authors.forename: Yume
authors.initials: Y
authors.lastname: Nagaoka
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Takeguchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Iwasawa
authors.forename: Ryou
authors.initials: R
authors.lastname: Tomaru
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Wada
authors.forename: Tohru
authors.initials: T
authors.lastname: Shimizu
authors.forename: Masako
authors.initials: M
authors.lastname: Ohtani
authors.forename: Kou
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Fukutake
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakao
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone