Collapsing glomeruopathy (CG) is a clinicopathologic variant of focal segmental glomerulosclerosis (FSGS) and is characterized by severe nephrotic syndrome, rapid progression to end stage renal disease, and features of visceral epithelial cell injury and glomerular capillary collapse. Such characteristics closely resemble those of HIV associated nephropathy. The frequency of CG has increased over the last decade. The cause of CG is unknown. The lesion has rarely been described in renal allografts with features similar to CG in native kidney. We recently identified allograft CG in a 44 year-old male patient who underwent biopsy for graft dysfunction after autodermic graft. The biopsy showed typical characteristics of CG. Serologically, the patient had no evidence of HIV infection. The renal function was not restored to normal in spite of methylprednisolone pulsing therapy. Now he is on conservative treatment with a functioning graft.
AIDS-Associated Nephropathy ; Biopsy ; Capillaries ; Epithelial Cells ; Glomerulosclerosis, Focal Segmental ; HIV Infections ; Humans ; Kidney ; Kidney Failure, Chronic ; Male ; Methylprednisolone ; Nephrotic Syndrome ; Transplantation, Homologous ; Transplants

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.
AIDS-Associated Nephropathy ; Anti-Retroviral Agents ; Biopsy ; Glomerulonephritis ; HIV ; HIV Infections ; Humans ; Lupus Erythematosus, Systemic ; Middle Aged ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Steroids

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.
AIDS-Associated Nephropathy ; Anti-Retroviral Agents ; Biopsy ; Glomerulonephritis ; HIV ; HIV Infections ; Humans ; Lupus Erythematosus, Systemic ; Middle Aged ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Steroids

Viral infections can be causative in many glomerular disease, and human immunodeficiency virus (HIV) infection is closely related to a collapsing focal segmental glomerulosclerosis (FSGS). This is known as HIV associated nephropathy (HIVAN) and is characterized clinically by proteinuria, often of sudden onset, with rapidly progressive renal dysfunction resulting in end stage renal disease (ESRD) over several months. Increasingly, other primary renal diseases are being described in HIV infected patients, including IgA nephropathy, an immune complex lupus-like neprhopathy, and tubulonephritis. We observed rare HIVAN case presenting membranous glomerulonephritis with nephrotic syndrome in a woman who was positive for HIV without hepatitis B viral infection. She was treated with Methylprednisolone 60 mg/day, zidovudine 600 mg/day, efavirenz 60 mg/day, and lamivudine 300 mg/day for 5 months. After treatment, proteinuria decreased from 4,092 mg/day to 419 mg/day and CD4 T cell count rose from 594/mL to 1,176/mL. The effectiveness and safety of corticosteroids in the treatment of HIVAN remained controversial but this case showed good response for steroid with triple antiviral therapy about HIVAN especially membranous glomerulonephritis.
Adrenal Cortex Hormones ; AIDS-Associated Nephropathy ; Antigen-Antibody Complex ; Cell Count ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous* ; Glomerulosclerosis, Focal Segmental ; Hepatitis B ; HIV Infections* ; HIV* ; Humans ; Kidney Failure, Chronic ; Lamivudine ; Methylprednisolone ; Nephrotic Syndrome ; Proteinuria ; Zidovudine