Am J Kidney Dis. 1997 Jul;30(1):116-9. Unique Identifier : AIDSLINE
We report the case of a patient with acquired immunodeficiency syndrome
(AIDS) who developed nephrotic syndrome and progressive renal failure
mimicking human immunodeficiency virus HIV)-associated focal segmental
glomerulosclerosis (FSGS) who required initiation of hemodialysis and
was found on renal biopsy to have membranous nephropathy. Hepatitis B
and C serologies were negative. Although she required hemodialysis, she
was treated with prednisone and experienced a progressive decline in her
serum creatinine from 10.1 mg/dL to 1.9 mg/dL, which permitted the
discontinuation of hemodialysis. After she abruptly discontinued
prednisone, her creatinine level increased to 4.8 mg/dL, and she
experienced marked worsening of her nephrotic syndrome. Resumption of
prednisone resulted in normalization of serum creatinine and reduction
in urine protein excretion. No adverse effects of prednisone occurred
during this time. She remains off of hemodialysis for 1 year with a
serum creatinine level of 1.0 mg/dL and urine protein excretion of 0.4
g/d. Although most patients with HIV infection, nephrotic-range
proteinuria, and renal failure have FSGS, a minority may have membranous
nephropathy. Although typically not a steroid-responsive lesion in the
setting of advanced renal failure, membranous nephropathy may be a
highly steroid-responsive lesion in the HIV-infected patient, and
treatment may help avert the need for dialysis in a patient population
that generally has a poor outcome on dialysis.
*Acquired Immunodeficiency Syndrome/COMPLICATIONS *Anti-Inflammatory
Agents, Steroidal/THERAPEUTIC USE *Glomerulonephritis,
Membranous/DIAGNOSIS *Glomerulonephritis, Membranous/DRUG THERAPY
*Kidney Failure, Chronic/DRUG THERAPY *Prednisone/THERAPEUTIC USE