Association of nephrotic syndrome with immune reconstitution inflammatory syndrome.
BACKGROUND
Up to 50% of patients with severe immune deficiency experience an excessive inflammatory response called immune reconstitution inflammatory syndrome (IRIS) after the initiation of antiretroviral therapy (ART). IRIS has been observed after various opportunistic infections with pathogens such as mycobacteria, including Bacille Calmette-Guérin, cryptococci, human herpesvirus-8, non-Hodgkin's lymphoma, and progressive multifocal leukoencephalopathy. Non-acquired immune deficiency-defining illnesses can also deteriorate after commencement of ART. Renal IRIS has been reported in a few patients with mycobacterial infections, but to the best of our knowledge no cases of nephrotic syndrome and IRIS have been described.


METHODS
We report the case of an infant with human immunodeficiency virus-1 (HIV-1) infection, Pneumocystis pneumonia, and encephalopathy. During immune reconstitution the patient developed nephrotic syndrome. Treatment of nephrotic syndrome was initiated with prednisone, an angiotensin-converting enzyme inhibitor (lisinopril), and low-molecular-weight heparin. ART was continued, but only a low level of lopinavir/ritonavir could be achieved. There was no relapse of nephrotic syndrome during 10 months of follow-up.


CONCLUSIONS
Nephrotic syndrome may occur in infants during immune reconstitution and should not be overlooked.
Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center of Child and Adolescent Health, University Duesseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany. petra.lankisch@med.uni-duesseldorf.de
Petra
P
Lankisch
Hans-Jürgen
HJ
Laws
Anne-Margret
AM
Wingen
Arndt
A
Borkhardt
Tim
T
Niehues
Jennifer
J
Neubert
D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D001927:Brain Diseases / Q000150:complications; D004338:Drug Combinations; D015658:HIV Infections / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced* / Q000503:physiopathology; D007223:Infant; D061466:Lopinavir / Q000008:administration & dosage / Q000009:adverse effects; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000503:physiopathology; D011020:Pneumonia, Pneumocystis / Q000150:complications; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects
D044966:Anti-Retroviral Agents; D004338:Drug Combinations; D061466:Lopinavir; D019438:Ritonavir