title: Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report.
abstract: We report on a case of a patient with HIV infection, diagnosed 18 months prior to the development of an anti-glomerular basement membrane (anti-GBM) rapidly progressive glomerulonephritis; this is probably the first report of such an association. A 30-year-old white man presented with elevation of serum creatinine (1.3 - 13.5 mg/dL within one month). At admission, the urinalysis showed proteinuria of 7.2 g/L and 8,000,000 erythrocytes/mL. Renal biopsy corresponded to a crescentic diffuse proliferative glomerulonephritis mediated by anti-GBM, and serum testing for anti-GBM antibodies was positive; antinuclear antibodies (ANA) and anti-neutrophilic cytoplasmic antibodies (ANCA) were also positive. The patient underwent hemodyalisis and was treated with plasmapheresis, cyclophosphamide and prednisone. The association described here is not casual, as crescentic glomerulonephritis is not common in HIV-positive patients, anti-GBM glomerulonephritis is rare and anti-GBM antibodies are frequently observed in HIV-positive subjects when compared to the overall population. Based on the current case and on the elevated frequency of the positivity for such antibodies in this group of patients, it is advisable to be aware of the eventual association between these two conditions and to promote an active search for anti-GBM antibodies and early diagnosis of eventual urinary abnormalities in HIV-positive subjects, considering the severity of anti-GBM glomerulonephritis.
authors.affiliation: Nephrology Service, Department of Medicine, Medical School, Federal University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Eduardo José Bellotto
authors.initials: EJ
authors.lastname: Monteiro
authors.forename: Daiane
authors.initials: D
authors.lastname: Caron
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Balda
authors.forename: Marcello
authors.initials: M
authors.lastname: Franco
authors.forename: Aparecido Bernardo
authors.initials: AB
authors.lastname: Pereira
authors.forename: Gianna Mastroianni
authors.initials: GM
authors.lastname: Kirsztajn
mesh_terms: D000328:Adult; D019867:Anti-Glomerular Basement Membrane Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000906:Antibodies / Q000097:blood; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D001323:Autoantibodies; D003520:Cyclophosphamide / Q000627:therapeutic use; D003956:Dialysis; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010956:Plasmapheresis; D011241:Prednisone / Q000627:therapeutic use
chemical_list: D000906:Antibodies; D019268:Antibodies, Antineutrophil Cytoplasmic; D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D007166:Immunosuppressive Agents; C051951:antiglomerular basement membrane antibody; D003520:Cyclophosphamide; D011241:Prednisone