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Abstract: PO0312

A Rare Case of Concomitant Acute Interstitial Nephritis (AIN) and HIV-Associated Nephropathy (HIVAN)

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Bhardwaj, Aditi, St Barnabas Hospital, Bronx, New York, United States
  • Jadav, Raja, St Barnabas Hospital, Bronx, New York, United States
  • Tirado, Jorge, St Barnabas Hospital, Bronx, New York, United States
  • Alzyood, Laith, St Barnabas Hospital, Bronx, New York, United States
  • Ibrahim, Jamil, St Barnabas Hospital, Bronx, New York, United States
  • Abdurham, Ahmed, St Barnabas Hospital, Bronx, New York, United States
  • Flores Chang, Bessy Suyin, St Barnabas Hospital, Bronx, New York, United States
Introduction

HIVAN is characterized by collapsing focal segmental glomerulosclerosis (FSGS), the most common cause of renal dysfunction in HIV patients. Whereas AIN causes only 10% of renal dysfunction in HIV patients and it is usually caused by drugs, infections, or dysimmune syndromes but not as a direct consequence of HIV infection. AIN caused by HIV itself is a rare phenomenon, with only one reported case in the literature.We present a case of AIDS presenting itself as acute renal failure secondary to AIN and HIVAN

Case Description

51-year-old male with a history of hypertension presented with abdominal discomfort, loss of appetite, and dark brown urine for one week. He denied medication use. Initial laboratory values of serum potassium 8.9 mEq/L, serum creatinine 18 mg/dL, serum bicarbonate 12 mEq/L. CT Abdomen showed no hydronephrosis. He underwent urgent hemodialysis for refractory hyperkalemia. Urinalysis showed pyuria with WBC clumps, and microalbumin-to-creatinine ratio of 27g/dL. Further workup revealed HIV-1 positive with a CD4 count of 5/mL and viral load of 2,680,000 copies/mL. Anti-retroviral therapy was started.Kidney biopsy was consistent with acute intestitial nephritis and collapsing FSGS. IV pulse steroids started for 3 days then oral prednisone with gradual improvement in the clinical status.Unfortunately, his clinical status deteriorated with an acute respiratory failure requiring intubation with multiorgan failure and refractory septic shock that resulted in demise

Discussion

AIN in HIV is rare with few case reports having been published in the literature. In this case, pulse dose steroids were use for treatment with a very limited response. Our aim is to remind physicians that AIN can be found in HIV with or withour glomerular disease.More data is needed to establish treatment guideliness and monitor patient closely for treatment response.