Acute renal failure and nephrotic range proteinuria due to amyloidosis in an HIV-infected patient.
Amyloidosis is an uncommon cause of renal disease in HIV-positive patients. Diagnosis is challenging, treatment options are limited, and prognosis remains poor. We discuss an HIV-positive patient with acute renal failure and nephrotic range proteinuria. The differential diagnosis included nephropathy due to trimethoprim/sulfamethoxazole, tenofovir, HIV, hepatitis C, heroin, or multifactorial causes. Serum and urine study findings were inconclusive. Rapid clinical deterioration ensued and a renal biopsy was performed. Pathologic examination revealed eosinophilic, amorphous material in the glomerular tufts that stained red-orange with Congo red stain. Immunohistochemical analysis confirmed amyloid A (AA) amyloidosis. AA amyloidosis occurs as a complication of chronic infection or chronic inflammatory disease. It has been reported in intravenous or subcutaneous drug abusers, some of whom were HIV-positive. This case underscores the importance of tissue diagnosis to determine the cause of renal disease in HIV-positive patients. Clinical diagnosis, based on CD4 count, viral load, and degree of proteinuria, may not predict the pathological diagnosis in HIV-positive patients.
Chan-Tack
Kirk M
KM
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. kchan@medicine.umaryland.edu
Ahuja
Navneet
N
Weinman
Edward J
EJ
Wali
Ravinder K
RK
Uche
Anayochukwu
A
Greisman
Lisa A
LA
Drachenberg
Cinthia
C
Hawkins
Philip N
PN
Redfield
Robert R
RR
D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000686:Amyloidosis / Q000150:complications*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D009401:Nephrosis / Q000209:etiology*
D019380:Anti-HIV Agents