HIV associated lupus like nephropathy

Abstract

BACKGROUND: Human immunodeficiency virus type 1 (HIV-1)-seropositive patients are at a high risk for the development of a variety of acute and chronic renal diseases. Most patients with HIVAN are of African descent, presenting late in the course of their HIV-1 infection. The only reliable test to establish or rule out the presence of HIVAN (HIV associated nephropathy) is renal biopsy. The most common lesion associated with HIV is a focal segmental glomeruloscelerosis, but several times, other biopsy findings may also be seen. Our patient had lupus nephritis like pathology picture. The therapeutic agents with the most promise are angiotensin-converting enzyme inhibitors and antiretroviral medications. Role of 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 like picture and wasting. On evaluation, he was found to be HIV-1 positive, and renal biopsy showed lupus nephritis like pathological picture. The patient was treated with HAART (Highly active anti retroviral therapy) , 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.