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Kidney Week

Abstract: SA-PO865

Human Immunodeficiency Virus-Associated Lupus-Like Nephritis: An Undetectable Viral Load and Negative Lupus Serology

Session Information

Category: Glomerular Diseases

  • 1401 Glomerular Diseases: From Inflammation to Fibrosis

Authors

  • Khan, Muhammad Zatmar, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Kidd, Jason M., Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Patrick, Kennerly Clinton, Virginia Commonwealth University Health System, Richmond, Virginia, United States

Group or Team Name

  • Katz Family Division of Nephrology and Hypertension.
Introduction

HIV is a common cause of a wide array of kidney abnormalities including both glomerular and tubular disorders. HIV associated immune complex kidney disease (HIVICK) is a unique entity which includes lupus like nephritis which presents without classic serologic findings of lupus. We describe the case of a 29year old man with HIV who was diagnosed with lupus like nephritis without a diagnosis of lupus.

Case Description

A 29year old man with a history of HIV on anti-retroviral therapy (ART) and chronic kidney disease stage 4 presented with dyspnea and acute kidney injury. Pertinent labs included serum creatinine of 3.7 mg/dl up from 2.7 mg/dl and urine dipstick positive for hematuria and proteinuria. Urine microscopy had acanthocytes. Spot urine protein creatinine ratio was 0.7 g/g. A broad serologic workup was performed which was unremarkable (Table). HIV viral load was undetectable. A kidney biopsy was performed. Mesangial expansion and hypercellularity was noted without crescents. There was patchy tubular atrophy and interstitial fibrosis. Immunofluorescence staining pattern was positive for Ig (Immunoglobulin) A, IgG, IgM, C (complement)1q, and C3. Electron microscopy showed multiple subepithelial and mesangial electron dense deposits. A diagnosis of lupus like glomerulonephritis was made. Given the undetectable viral load kidney function was monitored closely without any active pharmacologic intervention.

Discussion

We present the case of HIV related immune complex glomerulonephritis. This case is unique because lupus like nephritis developed despite an undetectable HIV viral load and negative lupus serologies. The pharmacologic therapy in such cases is a subject for research. The optimal treatment remains unknown as of yet.

Pertinent serologic markers
Anti nuclear antibody (ANA)-cryoglobulin-
C3136 mg/dl (80-200)rheumatoid factor-
C430 mg/dl (10-50)kappa/lamba1.2 (0.2-1.6)
Anti double stranded-DNA, Phospholipase A 2 receptor Antibody, anti-histone Ab-Hepatitis B surface antigen-
Anti neutrophil cytoplasmic antibody-hepatitis C antibody-