HIV ASSOCIATED LUPUS LIKE NEPHROPATHY

Abstract

BACKGROUND: Human immunodeficiency virus type 1 (HIV-1)–seropositive patients are at a high riskfor the development of a variety of acute and chronic renal diseases. Most patients with HIVAN are ofAfrican descent, presenting late in the course of their HIV-1 infection. The only reliable test to establishor rule out the presence of HIVAN (HIV associated nephropathy) is renal biopsy. The most commonlesion associated with HIV is a focal segmental glomeruloscelerosis, but several times, other biopsyfindings may also be seen. Our patient had lupus nephritis like pathology picture. The therapeutic agentswith the most promise are angiotensin-converting enzyme inhibitors and antiretroviral medications. Roleof steroids are less well-defined although they have been used with success many times.CASE DETAILS: Our patient was a young male who presented with a pulmonary renal syndrome likepicture and wasting. On evaluation, he was found to be HIV-1 positive, and renal biopsy showed lupusnephritis like pathological picture. The patient was treated with HAART (Highly active anti retroviraltherapy) , steroids and ACE inhibitors and showed an excellent response.CONCLUSION: The case highlights the fact that immune mediated glomerulonephritis, although rare,can be the presenting feature of HIV infection and can be controlled, if not cured, with proper treatment.