Dual Glomerular Lesion in Hiv Patient

Abstract

HIV-associated nephropathy (HIVAN), the classic kidney disease associated with HIV infection, was first described in 1984 as a complication of AIDS although HIVAN may also occur in patients with less advanced HIV infection or following acute seroconversion Histologically, HIVAN is a collapsing form of focal segmental glomerulosclerosis (FSGS) accompanied by microcystic tubular dilatation and interstitial inflammation. HIV-immune complex kidney disease (HIVICK). Other immune complex diseases may also occur in HIV-infected patients, including IgA nephropathy and postinfectious glomerulonephritis, and are best diagnosed as those specific entities The pathophysiological mechanism of HIVAN injury is mediated by direct infection of renal epithelial cells by HIV, expression of intrarenal viral genes, and dysregulation of host genes by modulating cell differentiation and the cell cycle. In contrast, kidney disease by HIV immune complexes (HIVICK) involves a different immune mechanism with antibody deposits within glomerular structures. Both entities progressively present different degrees of proteinuria and progressive decrease in the glomerular filtration rate, depending on the commitment or histology suffered by the patient. In this case reports patient with clinical picture of 3 months of evolution of temporo-spatial disorientation and alteration of the state of consciousness associated with hyperthermia. We perform neuroimaging without alterations, a lumbar puncture performed with evidence of an infectious process by coconuts + in the GRAM of the cerebrospinal fluid, normochromic normocytic anemia and renal failure, sub nephrotic proteinuria, glomerular hematuria, HIV positive, recount of normal CD4, renal biopsy with diagnosis of immune-mediated glomerulonephritis (IgG and C3), in the immunofluorescence (HIVICK) and with membrano pattern proliferative and in two glomeruli focal segmental sclerosis collapsing variant (HIVAN)is observed.