1/9. foscarnet-induced crystalline glomerulonephritis with nephrotic syndrome and acute renal failure after kidney transplantation.foscarnet nephrotoxicity has been reported to be associated with acute tubulointerstitial nephritis. Crystals in glomerular capillary lumens have also been observed in patients with acquired immunodeficiency syndrome who were treated with foscarnet for cytomegalovirus disease. We describe a kidney transplant recipient who developed a nephrotic syndrome with microscopic hematuria and nonoliguric acute renal failure within 15 days after starting foscarnet therapy for cytomegalovirus infection. A kidney biopsy specimen showed the presence of crystals in all glomeruli and in proximal tubules. Fourier transform infrared microscopy analysis demonstrated that crystals were made from several forms of foscarnet salts: mixed calcium and sodium salts, and unchanged trisodium foscarnet salts. Renal function and proteinuria spontaneously improved, and a second transplant biopsy performed 8 months after the first one revealed fibrotic organization of half of the glomeruli and of interstitial tissue, and crystal vanishing. We were thus able to provide proof of the possible precipitation of foscarnet in a transplanted kidney.- - - - - - - - - - ranking = 1keywords = nephrotic syndrome (Clic here for more details about this article) |
2/9. Resolution of HIV-associated nephrotic syndrome with highly active antiretroviral therapy delivered by gastrostomy tube.There is no consensus regarding the specific management of HIV-associated nephrotic syndrome. We report a child whose first manifestation of human immunodeficiency virus type 1 (hiv-1) infection was nephropathy and wasting syndrome associated with profound immunodeficiency. The patient had a dramatic clinical and immunologic response to triple antiretroviral therapy delivered through a gastrostomy tube, with complete resolution of nephrotic syndrome. A 51/2-year-old African-American girl presented with a 2-week history of cough, chest pain, vomiting, loose stools, abdominal distention, anorexia, and fever. In addition, she had recurrent oral thrush. Her weight and height were below the 5th percentile. She was chronically ill, appearing with oropharyngeal thrush and pitting edema in lower extremities. She had scattered rhonchi and decreased breath sounds on both lung bases. Her abdomen was distended and diffusely tender. A chest radiograph showed consolidation of the right upper and left lower lobes with bilateral pleural effusion. Admission laboratories were consistent with nephrotic syndrome. streptococcus pneumoniae grew from the blood culture and the child responded well to treatment with intravenous ceftriaxone. She was found to be HIV-infected, her CD4( ) cell count was 3 cells/mcL and her plasma hiv-1 rna was >750 000 copies/mL. A percutaneous gastrostomy tube was placed for supplemental nutrition. She was treated with stavudine, lamivudine, and nelfinavir via gastrostomy tube with good clinical response. Twenty-one months after instituting antiretroviral therapy, her weight and height had increased to the 50th and 10th percentile respectively, and she had complete resolution of her nephrotic syndrome. Her CD4( ) cell count increased to 1116 cells/mcL and her viral load has remained undetectable. hiv-1 associated nephrotic syndrome has been described in children with profound immunodeficiency. The course of untreated HIV-associated nephrotic syndrome is rapid progression to renal failure in up to 40% of the children. Regardless of the presence of renal insufficiency, if untreated, it is uniformly fatal. A modest improvement of hiv-1 associated nephrotic syndrome has been observed in patients treated with zidovudine. Steroid and cyclosporine treatment have resulted in improved renal function but long-term use of immunosuppressive therapy has raised concerns about safety. We have described, to our knowledge, the first child with HIV-associated nephrotic syndrome who had a remarkable clinical, immunologic, and virologic response to triple-drug combination therapy given by gastrostomy tube, with complete resolution of proteinuria and normalization of the serum albumin. She also had a striking improvement in weight, height, and quality-of-life. Whether the presence of a gastrostomy tube contributed to the excellent response because of improved compliance is unknown, but warrants systematic evaluation.- - - - - - - - - - ranking = 2.4keywords = nephrotic syndrome (Clic here for more details about this article) |
3/9. lupus nephritis in a child with AIDS.Concomitant acquired immunodeficiency syndrome (AIDS) and lupus nephritis is an exceptional feature in white patients. A white boy with maternofetal human immunodeficiency virus (HIV) infection had no medical follow-up until he presented at 12 years of age with a nephrotic syndrome, macrohematuria, renal failure, pancytopenia, and low CD4( ) cell count. A renal biopsy revealed severe lupus nephritis (world health organization class IV) with specific immune deposits in the absence of any clinical sign of systemic lupus erythematosus or specific autoantibodies at the time of diagnosis. The treatment consisted of methylprednisolone pulses followed by oral prednisone; antiretroviral triple therapy was started a few weeks later, which contributed to clinical and biologic improvement. To our knowledge, this is the first case report of lupus-like nephritis in a white child with AIDS, whose outcome might be improved significantly by a combination of steroids and antiretroviral therapy.- - - - - - - - - - ranking = 0.2keywords = nephrotic syndrome (Clic here for more details about this article) |
4/9. nephrotic syndrome due to thrombotic microangiopathy (TMA) as the first manifestation of human immunodeficiency virus infection: recovery before antiretroviral therapy without specific treatment against TMA.BACKGROUND: Among the possible renal complications that can develop a human immunodeficiency virus- (HIV) infected patient, thrombotic microangiopathy (TMA) is one of them. This is a type of vascular lesion more common in HIV patients than in normal population, and sometimes it can be the first manifestation of the HIV infection. methods: We present a patient with TMA in whom the subsequent investigation to find the cause of TMA revealed HIV infection and giardia lamblia in stool. RESULTS: Before antiretroviral therapy was started the patient began to show recovery of the hemolytic anemia, recovery of the nephrotic syndrome and partial remission of the proteinuria, so that he did not receive specific therapy for TMA. CONCLUSIONS: HIV infection should be suspected in patients presenting with TMA, and a HIV test should be routinely performed as part of the initial clinical evaluation of TMA. If the patients have not developed acquired immunodeficiency syndrome, the prognosis of TMA is equal to non-infected ones.- - - - - - - - - - ranking = 0.2keywords = nephrotic syndrome (Clic here for more details about this article) |
5/9. diagnosis and treatment of HIV-associated nephropathy.Human immunodeficiency virus-associated nephropathy (HIVAN) is a distinct clinico-pathological syndrome that occurs almost exclusively in black patients with an AIDS defining diagnosis. It is characterized by rapidly progressive renal failure with a severe nephrotic syndrome. The renal biopsy typically shows a collapsing glomerular sclerosis and variable tubulo-interstitial nephritis. The pathogenesis most likely involves infection of renal tubular and epithelial cells with HIV. The use of ACE-inhibitors and steroids may slow down the progression to end-stage renal failure. With the introduction of highly active anti-retroviral therapy, HIVAN may now be treated effectively although clinical data are so far limited to case-reports.- - - - - - - - - - ranking = 0.2keywords = nephrotic syndrome (Clic here for more details about this article) |
6/9. Spontaneous improvement of the renal function in a patient with HIV-associated focal glomerulosclerosis.Collapsing glomerulopathy is a pattern of renal injury that is seen in association with human immunodeficiency virus (HIV) infection. patients with this HIV-associated nephropathy (HIVAN) present nephrotic syndrome and rapid deterioration of the renal function. There is no proven effective therapy for HIVAN, and the majority of the patients become dialysis dependent. We report a case of biopsy-proven HIVAN that showed spontaneous improvement of the renal function.- - - - - - - - - - ranking = 0.2keywords = nephrotic syndrome (Clic here for more details about this article) |
7/9. Intracranial venous sinus thrombosis complicating aids-associated nephropathy.An alert and oriented 27-year-old African American woman with AIDS presented with a 10-day history of fever, cough productive of yellow sputum, nausea, and vomiting and a 1-day history of excruciating headache and photophobia. Her condition rapidly deteriorated into a coma with decorticate and then decerebrate posture, and she died 3 weeks later. There was evidence of extensive intracranial venous sinus thrombosis (ICVST), renal vein thrombosis (RVT), and multiple cerebral hemorrhagic infarcts due to a hypercoagulable state complicating AIDS-associated nephrotic syndrome. This is the first reported case of fatal ICVST and RVT with extensive cerebral hemorrhagic infarcts complicating nephrotic syndrome in a patient with AIDS.- - - - - - - - - - ranking = 0.4keywords = nephrotic syndrome (Clic here for more details about this article) |
8/9. Corticosteroid therapy in a Chinese patient with nephropathy associated with human immunodeficiency virus infection.A 52-year-old man with 6 years' history of human immunodeficiency virus infection who was receiving highly active antiretroviral therapy presented with acute renal failure and nephrotic syndrome. Renal biopsy revealed features consistent with nephropathy associated with human immunodeficiency virus infection. Treatment consisted of intravenous methylprednisolone followed by oral prednisolone. The patient's renal function improved, although proteinuria persisted. Human immunodeficiency virus-associated nephropathy is very rare in Asian populations and is more common among blacks. To the best of our knowledge, this is the first documented case of nephropathy associated with human immunodeficiency virus infection occurring in hong kong.- - - - - - - - - - ranking = 0.2keywords = nephrotic syndrome (Clic here for more details about this article) |
9/9. Late renal allograft failure secondary to thrombotic microangiopathy-human immunodeficiency virus nephropathy.The case of a renal transplant recipient with a known history of iv drug abuse but unknown human immunodeficiency virus (HIV) status who presents after having a stable renal allograft function for 4 yr, with acute/subacute advanced renal failure, nephrotic syndrome, and hypertension, as well as clinical and histologic findings of thrombotic microangiopathy, is reported. He was subsequently found to have a positive serology for hiv-1 with a low CD4 count but no clinical manifestations of the acquired immunodeficiency syndrome. He was treated conservatively with zidovudine (AZT). The patient never regained graft function and was ultimately discharged from the hospital on maintenance dialytic therapy. This is, to our knowledge, the first report of thrombotic microangiopathy in an hiv-1-infected patient presenting late in the course as acute/subacute renal allograft failure.- - - - - - - - - - ranking = 0.2keywords = nephrotic syndrome (Clic here for more details about this article) |