The uncertain significance of anti-glomerular basement membrane antibody among HIV-infected persons with kidney disease.
Glomerular lesions that complicate patients with human immunodeficiency virus (HIV) infection include HIV-associated nephropathy, membranous glomerulopathy, and immune-complex glomerulonephritides. This case series presents 3 patients with clinically significant renal disease and positive test results for anti-glomerular basement membrane (anti-GBM) antigen. Characteristic histological findings that would suggest anti-GBM antibodies have a significant role in the pathological state of each patient's kidney disease were absent. In addition, each patient recovered without specific treatment for anti-GBM disease. This case series suggests that anti-GBM antibodies likely are related to the B-cell expansion previously described in patients with HIV infection. We propose that clinicians interpret results of anti-GBM antibody tests carefully for patients with HIV infection, considering biopsy before empiric therapy, particularly in a clinical presentation that is atypical for Goodpasture disease.
Szczech
Lynda Anne
LA
Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA. szcze001@mc.duke.edu
Anderson
Albert
A
Ramers
Christian
C
Engeman
John
J
Ellis
Matthew
M
Butterly
David
D
Howell
David N
DN
D016263:AIDS-Associated Nephropathy / Q000209:etiology / Q000276:immunology* / Q000473:pathology; D000328:Adult; D019867:Anti-Glomerular Basement Membrane Disease / Q000276:immunology / Q000473:pathology; D000906:Antibodies / Q000097:blood* / Q000502:physiology; D001323:Autoantibodies; D001402:B-Lymphocytes / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male
D000906:Antibodies; D001323:Autoantibodies; C051951:antiglomerular basement membrane antibody