Abstract: PUB157
Diabetic Glomerulosclerosis Mimicking HIV-Associated Nephropathy
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Alnablsi, Mhd Wisam, South Texas Health System, Edinburg, Texas, United States
- Neidig, Briana, South Texas Health System, Edinburg, Texas, United States
- Alsabbagh, Mourad, South Texas Health System, Edinburg, Texas, United States
Introduction
HIV-associated nephropathy (HIVAN) commonly presents with nephrotic-range proteinuria and rapid progression to kidney failure, although non-HIV-specific renal diseases may mimic HIVAN clinically.
Case Description
A 46-year-old woman with untreated HIV infection, poorly controlled type 2 diabetes mellitus, and longstanding medication nonadherence presented with progressive edema and abdominal distention. Laboratory evaluation demonstrated hemoglobin 6.4 g/dL, hemoglobin A1c 10.2%, HIV viral load 140,000 copies/mL, CD4 count 50 cells/µL, and nephrotic-range proteinuria with urine protein-creatinine ratio of 3.7 g/g. Imaging showed diffuse anasarca, pleural effusions, and pulmonary edema. Give immunosuppression and proteinuria, HIVAN was initially suspected. Kidney biopsy instead demonstrated nodular diabetic glomerulosclerosis. No collapsing glomerulopathy identified.
Discussion
Despite clinical findings strongly suggestive of HIVAN, biopsy established diabetic glomerulosclerosis as the primary etiology of nephrotic syndrome. Untreated HIVAN typically progresses rapidly over months, whereas diabetic nephropathy evolves over years to decades, making HIVAN the more clinically anticipated diagnosis in severely immunocompromised patients. This case highlights the importance of kidney biopsy in establishing the correct diagnosis.
Clinicopathologic Comparison of HIVAN and Diabetic Glomerulosclerosis
| Feature | HIVAN | Diabetic Nephropathy | Patient |
| Typical Progression | Months | Years-decades | Rapid edema/proteinuria |
| Proteinuria | Nephrotic Range | Nephrotic possible | Present |
| HIV viral load | High | N/A | 140,000 |
| Biopsy Finding | Collapsing FSGS | Nodular Sclerosis | Nodular sclerosis |
| Final Diagnosis | ---- | Consistent with | Diabetic glomerulosclerosis |
HIVAN = HIV-associated nephropathy; FSGS = focal segmental glomerulosclerosis. Kidney biopsy established diabetic glomerulosclerosis as the primary etiology of nephrotic syndrome.