Acute renal failure associated with immune restoration inflammatory syndrome.
BACKGROUND
A 30-year-old HIV-infected woman presented with fever and abdominal pain 4 days after initiation of highly active antiretroviral therapy (HAART), and 1 month after initiation of antimicrobial therapy for Mycobacterium tuberculosis infection. A diagnosis of immune restoration inflammatory syndrome (IRIS) was considered, and corticosteroids were started. Steroid therapy doses were progressively tapered, during which time the patient developed renal failure with enlarged kidneys. A renal biopsy showed acute interstitial nephritis. Extensive investigations failed to detect active infection. The efficacy of HAART was attested by increased CD4+ cell counts and undetectable viral replication.


METHODS
Physical examination, plasma viral load and CD4+ cell count, abdominal and renal ultrasound, renal and peritoneal biopsies, renal and liver function, chest X-ray, and bronchoalveolar lavage culture.


METHODS
Acute renal failure secondary to IRIS.


RESULTS
Prednisone therapy.
Daugas
Eric
E
Department of Nephrology, Tenon Hospital, Paris, France.
Plaisier
Emmanuelle
E
Boffa
Jean-Jacques
JJ
Guiard-Schmid
Jean-Baptiste
JB
Pacanowski
Jerôme
J
Mougenot
Béatrice
B
Ronco
Pierre
P
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000503:physiopathology*; D011241:Prednisone / Q000494:pharmacology
D000893:Anti-Inflammatory Agents; D011241:Prednisone