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Anti-glomerular basement membrane disease in an HIV-infected patient

Nature Clinical Practice Nephrology volume 4, pages 167–171 (2008)Cite this article

Abstract

Background A 55-year-old HIV-positive male presented with gross hematuria, proteinuria, acute azotemia, and recurrent left hip septic arthritis. Anti-glomerular basement membrane (anti-GBM) antibodies were present in the patient's serum, and eosinophils were noted in his urine. Renal biopsy revealed active crescents, with linear staining of the capillary wall for IgG consistent with anti-GBM nephritis.

Investigations Physical examination, blood and urine analyses, chest X-ray, CT imaging of the abdomen and pelvis, renal ultrasound, and renal biopsy.

Diagnosis Anti-GBM disease.

Management Owing to the presence of active HIV infection and recurrent left hip septic arthritis, a novel approach to treatment was pursued in the hope of reducing infectious consequences. The patient received steroids, intravenous immunoglobulin, rituximab, and mycophenolate mofetil.

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Figure 1: Glomerulus with fibrin and cells in the urinary space (arrows), forming a crescent.
Figure 2: Immunofluorescence microscopy of glomeruli.

References

  1. Savige JA et al. (1994) Anti-nuclear, anti-neutrophil cytoplasmic and anti-glomerular basement membrane antibodies in HIV-infected individuals. Autoimmunity 18: 205–211

    Article  CAS  Google Scholar 

  2. Szczech LA et al. (2006) The uncertain significance of anti-glomerular basement membrane antibody among HIV-infected persons with kidney disease. Am J Kidney Dis 48: e55–e59

    Article  Google Scholar 

  3. Monteiro EJ et al. (2006) Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report. Braz J Infect Dis 10: 55–58

    Article  Google Scholar 

  4. Beaufils H et al. (1995) HIV-associated IgA nephropathy—a post-mortem study. Nephrol Dial Transplant 10: 35–38

    Article  CAS  Google Scholar 

  5. Hsieh WS et al. (1992) Crescentic IgA nephropathy and acute renal failure in an HIV-positive patient with enteric salmonella infection. Nephrol Dial Transplant 11: 2320–2323

    Article  Google Scholar 

  6. Katz A et al. (1992) IgA nephritis in HIV-positive patients: a new HIV-associated nephropathy? Clin Nephrol 38: 61–68

    CAS  PubMed  Google Scholar 

  7. Kenouch S and Mery JP (1992) AIDS and IgA nephropathy. Nephron 61: 473

    Article  CAS  Google Scholar 

  8. Jindal KK et al. (1991) Crescentic IgA nephropathy as a manifestation of human immune deficiency virus infection. Am J Nephrol 11: 147–150

    Article  CAS  Google Scholar 

  9. Phelps RG and Turner AN (2000) Antiglomerular basement membrane disease and Goodpasture's syndrome. In Comprehensive Clinical Nephrology, edn 2, 331–340 (Eds Johnson RA and Feehally J) Philadelphia: Elsevier

    Google Scholar 

  10. Arzoo K et al. (2002) Treatment of refractory antibody mediated disorders with an anti-CD20 monoclonal antibody (rituximab). Ann Rheum Dis 61: 922–924

    Article  CAS  Google Scholar 

  11. Ruggenenti P et al. (2003) Rituximab in idiopathic membranous nephropathy: a one-year prospective study. J Am Soc Nephrol 14: 1851–1857

    Article  CAS  Google Scholar 

  12. Pescovitz MD et al. (2006) Resolution of recurrent focal segmental glomerulosclerosis proteinuria after rituximab treatment. N Engl J Med 354: 1961–1963

    Article  CAS  Google Scholar 

  13. Salama AD and Pusey CD (2006) Drug insight: rituximab in renal disease and transplantation. Nat Clin Pract Nephrol 2: 221–230

    Article  CAS  Google Scholar 

  14. O'Riordan A et al. (2005) Pulmonary renal syndrome due to anti-GBM and IgM C-ANCA disease requiring the use of novel therapeutic agents. Ren Fail 27: 791–794

    Article  Google Scholar 

  15. Garcia-Canton C et al. (2000) Goodpasture's syndrome treated with mycophenolate mofetil. Nephrol Dial Transplant 15: 920–922

    Article  CAS  Google Scholar 

  16. Selamet U et al. (2007) ANCA-associated vasculitis: new options beyond steroids and cytotoxic drugs. Expert Opin Investig Drugs 16: 689–703

    Article  CAS  Google Scholar 

  17. [No authors listed] Rituxan warning (2007) FDA Consum 41: 3

  18. Berger JR and Houff S (2006) Progressive multifocal leukoencephalopathy: lessons from AIDS and natalizumab. Neurol Res 28: 299–305

    Article  CAS  Google Scholar 

  19. Kishida S (2007) Progressive multifocal leukoencephalopathy—epidemiology, clinical pictures, diagnosis and therapy. Brain Nerve 59: 125–137

    CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. E Wechsler and T Yang are Nephrology Fellows in the Department of Nephrology, A Vo is Director of Immunotherapy in the Department of Transplant Immunology, and CC Nast is Associate Director of Renal Pathology in the Department of Pathology, SC Jordan is Director of Transplant Immunology and Adult and Pediatric Nephrology, all at the Cedars–Sinai Medical Center, Los Angeles, CA, USA.,

    Eric Wechsler, Tom Yang, Stanley C Jordan, Ashley Vo & Cynthia C Nast

Authors
  1. Eric Wechsler
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  2. Tom Yang
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  3. Stanley C Jordan
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  4. Ashley Vo
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Corresponding author

Correspondence to Eric Wechsler.

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Competing interests

SC Jordan has grant support from Genentech, South San Francisco, CA, USA. Rituxan® (rituximab) is comarketed by Genentech and Biogen Idec in the US. There were no financial arrangements between the author and Genentech. The other authors declared no competing interests.’ This is taken from the online-only form

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Wechsler, E., Yang, T., Jordan, S. et al. Anti-glomerular basement membrane disease in an HIV-infected patient. Nat Rev Nephrol 4, 167–171 (2008). https://doi.org/10.1038/ncpneph0724

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