Case of serious HIV-associated nephropathy resulting in the introduction of hemodialysis

• Published in: Nihon Jinzo Gakkai shi Vol. 55; no. 7; p. 1335
• Main Authors: Sasaki, Emi, Shibata, Maki, Kato, Asami, Hamano, Naoto, Katsuki, Takashi, Katsuma, Ai, Tada, Manami, Hinoshita, Fumihiko
• Format: Journal Article
• Language: Japanese
• Published: Japan 2013
• Subjects: Acute Disease; AIDS-Associated Nephropathy - complications; AIDS-Associated Nephropathy - diagnosis; AIDS-Associated Nephropathy - pathology; AIDS-Associated Nephropathy - therapy; Disease Progression; Humans; Male; Middle Aged; Renal Dialysis; Renal Insufficiency - etiology; Renal Insufficiency - therapy
• ISSN: 0385-2385

A previously healthy 46-year-old black man visited the other hospital because of fever, appetite loss and nausea. Renal dysfunction, liver injury, and a highly markedly elevated LDH level were found. Abdominal CT demonstrated enlarged liver, spleen, kidney and lymph nodes. Human immunodeficiency virus (HIV) was serologically positive. His serum BUN, creatinine and potassium were 74.9 mg/dL, 11.78 mg/dL, and 5.6 mEq/L, respectively. After admission, anuria persisted and the progression of renal failure continued despite various treatment methods, necessitating the introduction of maintenance hemodialysis(HD). A kidney biopsy was performed to confirm classical HIV-associated nephropathy (HIVAN). Antiretroviral therapy (ART) was started. Although urine was transiently excreted, HD could not be discontinued. It has been reported that HIVAN is too difficult to treat and that kidney dysfunction seldom recovers. HIVAN is well-known to occur frequently in black HIV-infected patients. However, in Japan, there have been only a few reports describing patients with serious HIVAN and renal failure necessitating HD. We present here a very rare case with HIVAN, with reference to some recent findings.