A Case of Membranous Glomerulonephritis in a Patient with HIV Infection

Korean Journal of Nephrology 2007;26(6):740-743.

Jae Seok Kim, M.D., Jae Won Yang, M.D., Min Soo Kim, M.D., Seung Tae Han, M.D. Bi Ro Kim, M.D., Hyo yeul Kim, M.D., Byoung Geun Han, M.D. and Seung Ok Choi, M.D.

Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

증례 : HIV 감염환자에서 발생한 막성사구체신염 1예

김재석 양재원 김민수 한승태 김비로 김효열 한병근 최승옥

연세대학교 원주의과대학 내과학교실

Abstract

Viral infections can be causative in many glomerular disease, and human immunodeficiency virus (HIV) infection is closely related to a collapsing focal segmental glomerulosclerosis (FSGS). This is known as HIV associated nephropathy (HIVAN) and is characterized clinically by proteinuria, often of sudden onset, with rapidly progressive renal dysfunction resulting in end stage renal disease (ESRD) over several months. Increasingly, other primary renal diseases are being described in HIV infected patients, including IgA nephropathy, an immune complex lupus-like neprhopathy, and tubulonephritis. We observed rare HIVAN case presenting membranous glomerulonephritis with nephrotic syndrome in a woman who was positive for HIV without hepatitis B viral infection. She was treated with Methylprednisolone 60 mg/day, zidovudine 600 mg/day, efavirenz 60 mg/day, and lamivudine 300 mg/day for 5 months. After treatment, proteinuria decreased from 4,092 mg/day to 419 mg/day and CD4 T cell count rose from 594/mL to 1,176/mL. The effectiveness and safety of corticosteroids in the treatment of HIVAN remained controversial but this case showed good response for steroid with triple antiviral therapy about HIVAN especially membranous glomerulonephritis.

Key Words: HIV infection, HIV associated nephropathy, Membranous glomerulonephritis