Abstract: PUB202
Lupus-Like Glomerulonephritis as the First Presentation of AIDS
Session Information
Category: Glomerular Diseases
- 1301 Glomerular Diseases: Fibrosis and Extracellular Matrix
Authors
- Hemmings, Stefan Ceru, Baptist Health, North Little Rock, Arkansas, United States
- Seales Kasangana, Maxine C., Baptist Health, North Little Rock, Arkansas, United States
Introduction
Crescentic Glomerulonephritis (GN) with Full House Immune Complex staining is typical of lupus nephritis and is an uncommon presentation of AIDS in the HAART era.
Case Description
A 21 yo Black man presented to hospital with chest pain and feeling generally unwell. One month earlier he presented to another hospital with abdominal pain and PR bleed. A CT abdomen was unremarkable and his creatinine was 1.0mg/dL then.
On exam he had normal blood pressure and a mild fever (Temp 100.1F). He was slim built with shotty cervical and axillary lymph nodes, without edema.
Labs showed mild anemia, Hb 10.9g/dL and creatinine 1.9mg/dL. On day 2 his creatinine was 1.96mg/dL. On urinalysis: 3+ blood and 3+ protein, UPCR 1.6g/g and albumin of 2.8. His CRP 3.4 and ESR >140mm/hr were elevated.
With a presumed GN diagnosis and suspicion for lupus, pulse methylprednisolone 1g daily x 3 doses was started. A renal biopsy performed on Day 4 revealed: "Focal Necrotizing and Crescentic GN with Full House Immune Complex staining". Serology was negative for ANA, dsDNA and ANCA. Complements were normal.
At follow up, review of his sexual history was significant for unprotected MSM starting only the year prior. Additional serology was significant for positive HIV antibodies and syphilis (1:64 titer). A CD4 count of 158 met AIDS criteria, with a viral load of 59,000 copies. Oral steroids were continued with a 4 month taper along with MMF. Biktarvy was initiated within 2 weeks of his HIV diagnosis. His creatinine normalized within 1 month (1.19mg/dL) and within 2 months his UA and UPCR (0.1g/g) were unremarkable. He had a normal CD4 count >400 and an undetectable viral load within 6 months.
Discussion
HIV-associated lupus-like GN is rare but well described in HIV positive individuals. HAART with steroids +/- MMF therapy early in disease can stabilize renal function. HIV testing should be performed more frequently in patients presenting with acute GNs.