Abstract: PUB614
Transient Nephrotic Range Proteinuria After Acute HIV Infection
Session Information
Category: Trainee Case Report
- 1204 Podocyte Biology
Authors
- Vissing, Andrew, Rush Children's Hospital, Chicago, Illinois, United States
- Jandeska, Sara E., Rush Children's Hospital, Chicago, Illinois, United States
Introduction
Nephrotic syndrome is common among patients living with HIV. Although the majority of cases are diagnosed with HIV-associated nephropathy, a collapsing FSGS variant, immune-mediated etiologies and minimal change disease have also been described. There is an absence of literature describing acute HIV infection and its immediate renal sequelae. We describe a case of transient nephrotic range proteinuria without features of minimal change disease.
Case Description
A 17-year-old African-American male presented with pharyngitis, abdominal pain, fever, and lymphadenopathy. HIV antibody was undetectable but viral load measured 1.3 million copies/ml (CD4 count 304 cells/ml) suggestive of acute HIV infection. He was discharged with darunavir, emtricitabine-tenofovir, and ritonavir.
Two weeks later, he presented with abdominal pain. Exam was notable for absence of edema. Chemistries showed acute kidney injury (BUN 25mg/dl, Cr 1.9mg/dl); a random protein/creatinine ratio was 9.2g/g. Serum albumin was 2.1 g/dl and cholesterol was 158 mg/dl. Work up of proteinuria was unremarkable. HIV viral load and CD4 count showed improvement on HAART.
A renal biopsy showed normal glomeruli with acute tubular necrosis and absence of immune deposits. Electron microscopy showed global podocyte effacement. He was prescribed steroids. Over the next four months, he was repeatedly admitted for abdominal pain but never exhibited edema or hypercholesterolemia. He refused to take steroids and was noncompliant with HAART. Proteinuria gradually resolved, and remission was achieved five months after biopsy.
Discussion
We describe the acute onset of nephrotic range proteinuria due to diffuse podocyte injury without the examination or laboratory features of minimal change disease. Proteinuria developed with reconstitution of T cell immunity and decrease in HIV viral load and resolved without pharmacologic therapy. We propose that asymptomatic podocytopathy early in the course of infection could be a novel form of HIV-mediated renal disease.