Coexistence of IgA Nephropathy and ANCA-Associated Vasculitis in an HIV Infected Patient: A Case Report
Article Sidebar
Main Article Content
Abstract
This case report presents a rare and complex scenario involving the coexistence of HIV infection, immunoglobulin A nephropathy (IgAN), and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis in a 40-year-old female. The patient, with a 4-year history of HIV, had been on consistent antiretroviral therapy and had a CD4 count of 374 cells per cubic millimeter. She presented with hematuria and rapidly declining renal function. The diagnosis was confirmed through kidney biopsy, revealing both IgA deposition and features of ANCA-associated vasculitis. The patient was successfully treated with a combination of high-dose corticosteroids and cyclophosphamide, leading to the stabilization of her renal function. This case underscores the challenges of managing such conditions, particularly in the context of an immunocompromised state, and highlights the importance of early recognition and timely intervention.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Beaufils H, Jouanneau C, Katlama C, Sazdovitch V, Hauw JJ. HIV-associated IgA nephropathy--a post-mortem study. Nephrol Dial Transplant. 1995;10(1):35-8.
Nobakht E, Cohen S, Rosenberg A, Kimmel PL. HIV-associated immune complex kidney disease. Nat Rev Nephrol. 2016;12(5):291-300.
Klaassen RJ, Goldschmeding R, Dolman KM, Vlekke AB, Weigel HM, Eeftinck Schattenkerk JK, et al. Anti-neutrophil cytoplasmic autoantibodies in patients with symptomatic HIV infection. Clin Exp Immunol. 1992 Jan;87(1):24-30.
Iordache L, Launay O, Bouchaud O, Jeantils V, Goujard C, Boue F, et al. Autoimmune diseases in HIV-infected patients: 52 cases and literature review. Autoimmun Rev. 2014;13(8):850-7.
Swanepoel CR, Atta MG, D’Agati VD, Estrella MM, Fogo AB, Naicker S, et al. kidney disease in the setting of HIV infection: conclusions from a kidney disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2018 Feb 2;93(3):545–59.
Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKD Atlas of Renal Pathology: HIV-Associated Immune Complex Kidney Disease (HIVICK). Am J Kidney Dis. 2016;68(2):e9-e10.
Paueksakon P, Najafian B, Alpers CE, Fogo AB. AJKD Atlas of Renal Pathology: IgA-Dominant Infection-Related Glomerulonephritis. Am J Kidney Dis. 2024;83(1): e1-e2.
Fenoglio R, Sciascia S, Baldovino S, Roccatello D. Acute kidney injury associated with glomerular diseases. Curr Opin Crit Care. 2019 Dec;25(6):573-9.
Sinico RA, Di Toma L, Radice A. Renal involvement in anti-neutrophil cytoplasmic autoantibody associated vasculitis. Autoimmun Rev. 2013 Feb;12(4):477-82.
Monach PA, Warner RL, Tomasson G, Specks U, Stone JH, Ding L, et al. Serum proteins reflecting inflammation, injury and repair as biomarkers of disease activity in ANCA-associated vasculitis. Ann Rheum Dis. 2013 Aug;72(8):1342-50.
Bulanov N, Chebotareva NV, Novikov PI, Moiseev SV. Role of tubulointerstitial injury in ANCA-associated vasculitis is underestimated. Ann Rheum Dis. 2019;78(10):e111.
KDIGO 2024 Clinical Practice Guideline for the Management of Antineutrophil Cytoplasmic Antibody (ANCA)–Associated Vasculitis. Kidney Int. 2024;106(Suppl 1):s71-s116.