Abstract
Human immunodeficiency virus (HIV)-positive individuals are at an increased risk for kidney diseases, including HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS), HIV immune complex disease of the kidney (HIVICK), and acute tubular necrosis (ATN). Non-modifiable factors such as age and genetics, as well as modifiable factors such as illicit drug use and compliance, define the progression to renal failure. The patient is a 64-year-old African American male with HIV, treated latent syphilis, chronic kidney disease stage 3a, and cocaine use disorder who presented with shortness of breath, bilateral lower extremities swelling, and fatigue with normal vitals and a physical exam remarkable for bibasilar inspiratory crackles with peripheral edema. Laboratory tests showed creatinine (Cr) of 2.23 mg/dL with a baseline of 1.5 mg/dL, albumin of 1.8, blood natriuretic peptide (BNP) of 667.88, and lipidemia. His urine was remarkable for proteinuria and microalbuminuria in the presence of cocaine. Immunofixation electrophoresis showed a marked increase in IgG and IgM, free lambda, and free kappa/free lambda ratio with HIV viral load of 39,400 copies/ml, absolute CD4 count of 56, and an acute hepatitis B panel. Renal biopsy confirmed HIVAN with FSGS accompanied by collapsing features, HIVICK, and ATN. The patient was subsequently started on highly active antiretroviral therapy (HAART) with prophylactic antibiotics and close monitoring.
Highlights
Human immunodeficiency virus type 1 (HIV-1) seropositive patients are at an increased risk for kidney diseases, including HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS), HIV immune complex disease of the kidney (HIVICK), and acute tubular necrosis (ATN)
We present the case history of a 64-year-old African American male with HIV who presented with nephropathy and was found to have HIVAN, HIVICK, and ATN
The pathogenic role of HIV replication in the development of HIVICK for patients on highly active antiretroviral therapy (HAART) reveals improvement of kidney function in patients who have detectable HIV RNA at the time that HIVICK diagnosis has been studied [14]. This case highlights that HIV-positive patients are at an increased risk of developing complex focal glomerular, immune, and tubular kidney pathologies, especially in the setting of acute infections, drugs, and non-compliance
Summary
Human immunodeficiency virus type 1 (HIV-1) seropositive patients are at an increased risk for kidney diseases, including HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS), HIV immune complex disease of the kidney (HIVICK), and acute tubular necrosis (ATN). Nonmodifiable factors such as age and genetics, as well as modifiable factors such as illicit drug use and compliance, define the progression to renal failure. He improved symptomatically throughout his hospitalization, was discharged on highly active antiretroviral therapy (HAART) with prophylactic antibiotics, and was recommended to follow up very closely with nephrology and infectious disease specialists
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