SHM Converge Scientific Abstract ePoster Gallery-Rapidly Progressive Chronic Renal Disease as Initial Presentation of Hiv Infection

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This case describes a 27-year-old African-American man with hypertension who presented with one week of nausea, vomiting, diarrhea, chest pain, dyspnea, sepsis, severe acute renal failure, metabolic acidosis, and marked proteinuria. He was found to be newly HIV-1 positive with advanced immunosuppression (CD4 count 23 cells/mm³) and high viral load. Despite heavy proteinuria, he had little to no peripheral edema or anasarca, raising concern for HIV-associated nephropathy (HIVAN), which was the presumptive diagnosis.<br /><br />His hospital course was complicated by multiple infections. He required emergent dialysis and bicarbonate therapy for renal failure and acidosis. Blood cultures grew Neisseria gonorrhoeae, treated with ceftriaxone. CMV viremia was detected and treated empirically as CMV colitis with IV ganciclovir. A positive RPR led to treatment for presumed secondary syphilis with penicillin G. He was started on HAART with darunavir/cobicistat/emtricitabine/tenofovir alafenamide and placed on trimethoprim-sulfamethoxazole for Pneumocystis prophylaxis. Because renal recovery was considered unlikely, he was discharged with outpatient dialysis planning.<br /><br />The report emphasizes that HIV can affect nearly any organ, and HIVAN is a major cause of renal failure in HIV-positive patients. HIVAN most often affects African-American men, typically presents with rapid progression to uremia, significant proteinuria, and minimal edema, and is associated histologically with collapsing glomerulopathy. Early HAART is the main treatment and improves outcomes, with adjunctive corticosteroids and ACE inhibitors or ARBs sometimes used.<br /><br />Key takeaway: HIV and HIVAN should remain in the differential diagnosis for rapidly progressive renal disease, especially when heavy proteinuria occurs without edema.

Asset Subtitle

John N. George

Meta Tag

Author List Bahram Dideban, Bhagwan Dass, John N. George, Michael Ladna, Nicolas N. Kattan, Nila S. Radhakrishnan, Riley G. Jones

Category Clinical Vignettes

Concept HIV-Associated Nephropathy

Concept Rapidly Progressive Kidney Injury

Concept HIV Coinfection

Concept Proteinuria

Concept HIV Therapy

Distinguished Non-Finalist

Presenter Organization University of Florida

Presenting Author John N. George

Track Adult

Keywords

HIV-associated nephropathy

HIV-1 infection

acute renal failure

proteinuria

African-American man

advanced immunosuppression

dialysis

sepsis

HAART

collapsing glomerulopathy

HIV-Associated Nephropathy

Rapidly Progressive Kidney Injury

HIV Coinfection

Proteinuria

HIV Therapy