MINIMAL CHANGE DISEASE IN PEOPLE LIVING WITH HIV: A CASE REPORT AND REVIEW OF THE LITERATURE.

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Various glomerular diseases are associated with human immunodeficiency virus (HIV) infection. However, the incidence of minimal change nephrotic syndrome has scarcely been reported. We describe a patient with a stage 4 HIV infection complaining of swelling in his face, hands, feet, genitals and an enlarged abdomen. Urinalysis revealed +3 proteins with normal urine sediment, and 2.1 g protein was found in the 24-hour analysis. Renal ultrasound showed bilateral glomerulopathies with hyperechoic and cortical thickening, a normal kidney size, and ascites. Kidney biopsy revealed acute tubular injury without HIV-associated nephropathy (HIVAN) features. The patient was treated with salt restriction, diuretics, captopril, methylprednisolone, and combined ART for 2 weeks and showed clinical improvement. Two weeks after the remission, the patient came to the outpatient department with a history of a 3-day cough with rust-colored sputum, fever, malaise, and shortness of breath. The lung auscultation revealed bilateral rhonchi and the chest x-ray result suggesting pneumonia. The patient was diagnosed with sepsis associated with healthcare-associated pneumonia but was not willing to be hospitalized and passed away at home. This study is limited to single-case nature and the possibility of sampling error. However, this case encourages further study in the field of HIV-associated renal diseases in providing clear recommendation in the management in special population.