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Kidney Week

Abstract: FR-PO211

Atypical Hemolytic Uremic Syndrome from Recent HIV Diagnosis

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Khan, Omar, Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas, United States
  • Mehboob, Wafa, Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas, United States
  • Patel, Hamad, Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas, United States
  • Ijaz, Fakhar, CHI St Vincent Infirmary, Little Rock, Arkansas, United States
Introduction

Atypical Hemolytic Uremic Syndrome (aHUS) is a rare thrombotic microangiopathic disorder characterized by reduced platelet counts, thrombocytopenia, and hemolytic anemia, often leading to kidney failure. It is associated with dysfunction of the Complement Alternative Pathway, and unlike Typical TMA, ADAMTS 13 activity levels are not low. While HIV-induced TMA has been documented, information on HIV-induced aHUS is limited. In this case, we present a rare instance of a patient with aHUS who was recently diagnosed with HIV.

Case Description

A 50-year-old male African American patient was recently diagnosed with HIV, with a CD4 count of 4 and a CD8 count of 158. He arrived at the hospital with complaints of abdominal pain, nausea, vomiting, generalized fatigue, and confusion. His Initial Lab results showed thrombocytopenia (plt:53k), anemia (Hgb:8), acute kidney injury (Cr:20, BUN:156), and accelerated hypertension. Tests for viral hepatitis, ANA, ANCA, and Syphilis were negative. The patient's renal biopsy revealed possible TMA with interstitial fibrosis and fibrin deposition. Plasmapheresis was initiated based on suspected TTP. Hemodialysis was started due to worsening renal failure and anuria. His ADAMTS13 levels were not low, suggesting atypical HUS. The patient's management was changed to Eculizumab therapy where his clinical condition and renal function improved after two doses. His dialysis was eventually discontinued.

Discussion

Existing literature links HIV with typical TMA, but no reports mention HIV-induced Atypical HUS. This case reveals a rare presentation of aHUS following a recent HIV diagnosis. HAART therapy is typically recommended but may take time to show clinical benefit, potentially leading to long-term dialysis due to irreversible scarring. This report demonstrates Eculizumab as an effective rapid therapy for acute TMA, allowing patients to improve without requiring long-term dialysis.

Renal Biopsy Showing Fibrin Deposition