Spontaneous Improvement of the Renal Function in a Patient with HIV-Associated Focal Glomerulosclerosis

Morales, Enrique; Martínez, Alberto Pastor; Sánchez-Ayuso, Javier; Gutiérrez, Eduardo; Mateo, Salvador de; Martı́nez, Miguel Ángel; Herrero, Juan Carlos; Praga, Manuel

doi:10.1159/000065229

Cited by 7 publications

(4 citation statements)

References 17 publications

(18 reference statements)

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“…When the renal artery occlusion to the solitary kidney was surgically repaired as late as six months after initiation of dialysis, the patient showed recovery of renal function [1]. Kato and his colleagues have reported recovery of renal function in their dialysis dependent patient who had cholesterol embolization to the kidneys causing loss of renal functions [2], while Morales and his colleagues reported spontaneous recovery of renal function in their patient who supposedly had renal failure due to FSGS associated with human immunodeficiency virus (HIV) infection [3]. Both of these conditions are widely believed to cause irreversible renal failure.…”

Section: Discussionmentioning

confidence: 99%

Recovery of renal function in dialysis patients

2003

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BackgroundAlthough recovery of renal functions in dialysis dependent patients is estimated to be greater than 1%, there are no indicators that actually suggest such revival of renal function. Residual renal function in dialysis patients is unreliable and seldom followed. Therefore renal recovery (RR) in dialysis dependent patients may remain unnoticed. We present a group of dialysis dependent patients who regained their renal functions. The aim of this project is to determine any indicators that may identify the recovery of renal functions in dialysis dependent patients.MethodsAll the discharges from the chronic dialysis facilities were identified. Among these discharges deaths, transplants, voluntary withdrawals and transfers either to another modality or another dialysis facility were excluded in order to isolate the patients with RR. The dialysis flow sheets and medical records of these patients were subsequently reviewed.ResultsEight patients with a mean age of 53.8 ± 6.7 years (± SEM) were found to have RR. Dialysis was initiated due to uremic symptoms in 6 patients and fluid overload in the remaining two. The patients remained dialysis dependent for 11.1 ± 4.2 months. All these patients had good urine output and 7 had symptoms related to dialysis. Their mean pre-initiation creatinine and BUN levels were 5.21 ± 0.6 mg/dl and 72.12 ± 11.12 mg/dl, respectively. Upon discontinuation, they remained dialysis free for 19.75 ± 5.97 months. The mean creatinine and BUN levels after cessation of dialysis were 2.85 ± 0.57 mg/dl and 29.62 ± 5.26 mg/dl, respectively, while the mean creatinine clearance calculated by 24-hour urine collection was 29.75 ± 4.78 ml/min. One patient died due to HIV complications. One patient resumed dialysis after nine months. Remaining continue to enjoy a dialysis free life.ConclusionRR must be considered in patients with good urine output and unresolved acute renal failure. Dialysis intolerance may be an indicator of RR among such patients.

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Section: Discussionmentioning

confidence: 99%

Recovery of renal function in dialysis patients

2003

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“…However, this treatment was not without significant side effects (Smith et al, 1994), so it should be limited to cases in which treatment with HAART have not produced any improvement and if we rule out opportunistic infections. Finally, we can find some curious case of spontaneous improvement of the glomerular pathology (Morales et al, 2002). The indications for renal replacement therapy with dialysis or transplantation in patients with HIVAN are similar to those followed in other chronic renal disease in the general population.…”

Section: Hiv-associated Nephropathymentioning

confidence: 82%

Glomerular Pathology in Patients with HIV Infection

Morales¹,

Gutiérrez‐Solís²,

Gutiérrez³

et al. 2011

An Update on Glomerulopathies - Clinical and Treatment Aspects

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“…While vascular diseases play a major role in the large series and in registry data, case reports, which are more prone to publication biases, mainly regard the more “charming” glomerular diseases and are mainly targeted at describing exceptional cases, highlighting the possibility of long-term recovery after various treatments, whether started in the pre-dialysis phase or performed during dialysis (29–37, 39–40) (Tab. II).…”

Section: Discussionmentioning

confidence: 99%

Chronic Dialysis Discontinuation: A Systematic Narrative Review of the Literature in the New Millennium

et al. 2014

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Introduction and aims Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is an uncommon occurrence. At a time when the “too early” start of dialysis is in discussion, a systematic review of the literature for cases in which patients recovered renal function after starting dialysis with chronic indications, including single cases and large series, may lead to attention being focused on this interesting issue. Methods The search strategy was built in Medline on Pubmed, in EMBASE and in the Cochrane Collaboration (August 2013) combining Mesh, Emtree and free terms: dialysis or hemodialysis, kidney function, renal function and recovery (publication date 2000-2013). The following tasks were performed in duplicate: titles and abstracts were manually screened, the data were extracted: title, author, objective, year, journal, period of study, multi-center, country, type of study. Results The systematic review retrieved 1 894 titles; 58 full papers were retrieved and the final selection included 24 papers: 11 case series or Registry data (4 from ANZdata) and 13 case reports. In spite of the high heterogeneity of the studies, overall they suggest that RFR occurs in about 1% of patients, without differences between PD and HD. RFR appears to be more frequent in elderly patients with renal vascular disease (up to 10% RFR in cholesterol emboli or scleroderma), but is reported in all types of primary and secondary kidney diseases. Conclusions RFR is a clinical event that should be looked for, particularly in elderly patients with vascular comorbidity.

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Spontaneous Improvement of the Renal Function in a Patient with HIV-Associated Focal Glomerulosclerosis

Cited by 7 publications

References 17 publications

Recovery of renal function in dialysis patients

Recovery of renal function in dialysis patients

Glomerular Pathology in Patients with HIV Infection

Chronic Dialysis Discontinuation: A Systematic Narrative Review of the Literature in the New Millennium

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