Abstract: TH-PO967
Lupus-Like Membranous Nephropathy in the Setting of Well-Controlled HIV Infection
Session Information
- Glomerular Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Prudhvi, Kalyan, Montefiore Medical Center/ AECOM, Bronx, New York, United States
- Fisher, Molly, Montefiore Medical Center/ AECOM, Bronx, New York, United States
Introduction
Immune complex glomerulonephritis associated with HIV infection encompasses a heterogeneous spectrum of glomerular diseases associated with immune deposits including membranous nephropathy. Membranous nephropathy with atypical features such as full house immune staining resembling lupus has been rarely described in HIV infection. We report a case of lupus like membranous nephropathy in the setting of well-controlled HIV infection successfully treated with rituximab.
Case Description
56-year-old Hispanic female with schizophrenia, type 2 diabetes mellitus, hypertension, HIV infection, and serum creatinine 0.7mg/dL presented with 5.3 grams of proteinuria. Her HIV infection was well-controlled with viral suppression on antiretroviral therapy and diabetes was controlled with no microvascular complications. Serologic workup included a positive ANA with a negative double stranded DNA antibody, normal C3 and C4 levels, negative SPEP, negative syphilis antibody, positive hepatitis C antibody and positive hepatitis B core antibody with viral suppression. Renal biopsy demonstrated immune complex glomerulonephritis with a membranous pattern. Full house staining was IgG predominant and numerous subepithelial, paramesangial deposits and tubuloreticular inclusions were seen. PLA2R stain was positive but serum anti-PLA2R antibody was negative. Although she had a positive ANA, she had no other clinical signs or symptoms of lupus. In the absence of another etiology, we concluded she had lupus like membranous nephropathy possibly associated with HIV infection. Despite conservative treatment for 6 months, proteinuria worsened to 7.1 grams. She was subsequently treated with rituximab. Within 2 months, her proteinuria improved to 3.1 grams consistent with partial remission.
Discussion
Lupus like glomerulonephritis with a membranous pattern has been rarely described in HIV infection. Our patient had a positive ANA but no other serological or clinical features of lupus. Although full house immune staining was seen, IgG predominated with mostly subepithelial deposits and her PLA2R stain was positive, suggesting this may be primary membranous nephropathy with atypical features. There are a variety of glomerular diseases observed in HIV positive individuals and this case highlights the importance of the renal biopsy for appropriate diagnosis and treatment