AKI in an HIV Patient

Abstract

The renal manifestations of patients infected with HIV are diverse. Patients may have podocytopathies ranging from a minimal-change-type lesions to FSGS or collapsing glomerulopathy. Furthermore, such patients produce a variety of autoantibodies without clinical signs of the disease. Antiretroviral drugs also cause renal injury, including crystals and tubular injury, acute interstitial nephritis, or mitochondrial toxicity. In these circumstances, it is essential to perform a renal biopsy for diagnosis and to guide treatment. Here we describe a patient with HIV who presented with AKI and hematuria without concomitant systemic manifestations. Renal biopsy elucidated the cause of acute deterioration of kidney function.

Acute kidney injury in patients with human immunodeficiency virus infection

“…Antiglomerular basement membrane antibody mediated cresentic GN causing AKI is reported in HIV patients. [ 28 ] We observed diffuse endocapillary proliferative GN in two cases causing AKI.…”

Microsporidium Infection–Associated Acute Kidney Injury in a Patient With HIV

“…Immune-J o u r n a l P r e -p r o o f complex glomerulonephritis, such as membranous nephropathy, focal segmental glomerulosclerosis, IgA nephropathy, and thrombotic microangiopathy are the other glomerular lesions associated with HIV. 3 AIN is a cause of AKI in up to 30% of HIV-infected patients. The majority of cases are associated with a drug hypersensitivity reaction, but other etiologies include infection, systemic disease, and immunologic syndrome, i.e.…”

“…1,2 The etiologies and kidney manifestations of AKI in this patient population are diverse; thus, performing a kidney biopsy is often necessary for accurate diagnosis and treatment. 3 Herein, we report a rare case of AKI secondary to acute plasma cell-rich interstitial nephritis associated with disseminated Microsporidium infection affecting the native kidneys in a patient with HIV.…”

Entanglement of Sepsis, Chronic Kidney Disease, and Other Comorbidities in Patients Who Develop Acute Kidney Injury

“…This CKD can manifest through a variety of mechanisms including podocyte injury (eg, HIVassociated nephropathy, focal segmental glomerular sclerosis) or immune complex disease (eg, IgA nephropathy, membranous, membranoproliferative glomerulonephritis), which often is related to co-infection with a hepatitis virus. 157,158 Medications represent another important source of AKI with highly active antiretroviral therapy nephropathy (eg, tenofovir, indinavir), acute crystalluria nephropathy (eg, acyclovir, indinavir), acute interstitial nephritis, and rhabdomyolysis (eg, zidovudine and didanosine). 157,159 A prospective cohort study of 56,823 HIV-infected patients in the Veterans Affairs registry showed that the incidence rate of AKI (defined as a 0.3-mg/dL absolute or 50% relative increase in serum creatinine concentration) decreased from 1996 to 2006.…”