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Kidney Week

Abstract: PO2111

HIV-Associated Lupus-Like Nephropathy in a Transplanted Kidney: An Etiology for CKD

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Shivaraj, Kiran, Westchester Medical Center, Valhalla, New York, United States
  • Me, Hay Me, Westchester Medical Center, Valhalla, New York, United States
Introduction

The mortality of chronic Kidney disease in HIV is about 3 times higher in patients with HIV when compared to non HIV. With improved coverage of antiretroviral therapies with incidence of HIVAN a form of collapsing FSGS are decreasing but HIVICK a immune mediated form of nephropathy is increasing. One particular type called the HIV associated Lupus Like nephropathy has been described classically in a native kidney, we describe this lesion in a transplanted kidney and might be the cause of chronic kidney disease.

Case Description

51 y o female patient with history of HIV on antiretroviral therapy who had a Living donor Kidney transplant from her HIV negative brother in about 4 years back and having a chronic kidney disease ckd stage 2 presented with intermittent watery diarrhea for 2 month and was found to have an acute kidney injury. The preliminary workup for Acute kidney injury including BK virus and DSA was negative . Renal transplant biopsy showed immune complex mediated glomerulonephritis with features of lupus like glomerulonephritis (full house stain with positive C1q), chronic transplant glomerulopathy with mild interstitial fibrosis and tubular atrophy, With a negative ANA and a negative ds DNA.

Discussion

The HIV lupus like nephropathy was picked up incidentally on biopsy while looking for acute rejection as the cause for the AKI which resolved with hydration. It was contributing to the underlying chronic elevated creatinine .The case is interesting as it has been described for the first time in a transplanted kidney and also that it's seen a kidney received from a non HIV donor as the pathogenesis requires the entry of viral particle into the renal cells in order to manifest the disease. The good immune system as indicated by the CD4 count and the viral titers supports the development of HIVICK. With the growing number of transplant in HIV positive patients HIV associated lupus like nephropathy a type of HIVICK should be considered as the cause of chronic elevated creatinine and might need adjustment of the immunosuppression accordingly.