Minimal change nephrotic syndrome in patients infected with human immunodeficiency virus: a retrospective study of 8 cases

Romain Arrestier,Anissa Moktefi,Flavia Vocila,Dil Sahali,David Buob,Guillaume Canaud,Nathalie Dejucq-Rainsford,Emmanuelle Plaisier,Corinne Isnard-Bagnis,Quentin Raimbourg,Isabelle Brocheriou,Philippe Gatault,Shao-Yu Zhang,Helene Francois,Anne-Pascale Satie,Anne-Elisabeth Heng,Vincent Audard,Marie Matignon

doi:10.1186/s12882-018-1132-x

Abstract

BackgroundHuman immunodeficiency virus (HIV) is associated with diverse glomerular diseases. Characteristics of minimal change nephrotic syndrome (MCNS) in this setting have been little studied, and the specific features of this uncommon association remain to be determined.MethodsWe conduct a retrospective study. Clinical, biological and pathological characteristics of patients with MCNS and HIV infection were assessed. We evaluated HIV infection by in situ hybridization and CMIP expression by immunochemistry on kidney biopsies and compared it to HIV-associated nephropathy (HIVAN) and idiopathic MCNS.ResultsEight patients were identifies. In all but one of these cases, MCNS occurred after HIV diagnosis (mean of 9.5 years). Acute kidney injury was detected in three cases. Mean CD4+ lymphocyte count was 733/mm3 and three patients had a detectable HIV viral load. In situ hybridization for HIV-1 RNA detection yielded a positive signal in a few tubular cells in the renal parenchyma in two of four patients with HIV infection associated with MCNS. Podocytes of these patients presented strong positive immunostaining for CMIP (4/4). Three patients suffered steroid-dependent nephrotic syndrome, and another two patients had at least one relapse. Rituximab treatment was initiated in four cases. After a median follow-up of 20 months, all patients were in remission (complete in 5 cases).ConclusionsIn patients with MCNS occurring in a context of HIV infection, podocyte injury seems to be associated with CMIP induction rather than renal HIV infection but further studies are needed to determine the molecular link between these two conditions.

Highlights

Human immunodeficiency virus (HIV) is associated with diverse glomerular diseases
In the course of studies on molecular mechanisms underlying the pathophysiological processes involved in minimal change nephrotic syndrome (MCNS) occurrence, we originally identified C-maf induction protein (CMIP) (c-maf inducing protein) as induced in T lymphocytes of patients with MCNS relapse but further studies have shown that CMIP is overproduced in podocytes of these patients, whereas it is downregulated in both tissues in MCNS remission [6, 7]
Clinical and biological data for patients with MCNS occurring in a context of HIV infection We retrospectively identified eight patients with a diagnosis of MCNS and HIV infection

Summary

Introduction

Human immunodeficiency virus (HIV) is associated with diverse glomerular diseases. Characteristics of minimal change nephrotic syndrome (MCNS) in this setting have been little studied, and the specific features of this uncommon association remain to be determined. Minimal change nephrotic syndrome (MCNS) is a glomerular disease characterized by massive selective proteinuria without glomerular lesions on light microscopy and with no immunoglobulin deposits on immunofluorescence study. An extensive review of seven renal pathology studies including a total of 949 patients showed MCNS to be the main renal biopsy finding in 10 patients (1.05% of cases), suggesting that MCNS is a rare finding in HIV-infected patients [11]. It remains unclear whether there is a real pathophysiological link between MCNS and HIV infection, or just a fortuitous association

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