Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report.
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.
Monteiro
Eduardo José Bellotto
EJ
Nephrology Service, Department of Medicine, Medical School, Federal University of São Paulo, São Paulo, SP, Brazil.
Caron
Daiane
D
Balda
Carlos Alberto
CA
Franco
Marcello
M
Pereira
Aparecido Bernardo
AB
Kirsztajn
Gianna Mastroianni
GM
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
D000906:Antibodies; D019268:Antibodies, Antineutrophil Cytoplasmic; D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D007166:Immunosuppressive Agents; C051951:antiglomerular basement membrane antibody; D003520:Cyclophosphamide; D011241:Prednisone