Hypertensive crisis as the first symptom of HIV-associated nephropathy — a case report
, 1, 1, 1, 12, 3, 4, 4, 3
Abstract
Introduction: Despite the observed reduction in the incidence of kidney diseases in patients with human
immunodeficiency virus (HIV) infection, kidney injury remains a diagnostic and therapeutic challenge. This case
presents a patient with HIV infection and kidney damage, who became a diagnostic and therapeutic challenge.
Case report: A 42-year-old female patient of East African origin was admitted to the Infectious Diseases
Clinic due to general fatigue, low urine output, generalized edema, and uncontrolled hypertension.
She was diagnosed with HIV infection two months before hospitalization, because of fast-progressing
anemia and kidney damage with hypertensive crisis (blood pressure values up to 220/120 mmHg) she
was sent to the hospital. Due to severe kidney injury, not improving after several hemodialysis procedures,
the patient was qualified for chronic hemodialysis (HDs) performed 3 times a week. Nonetheless,
by the time of submission of the manuscript HDs were performed without any complications. After repetitive
hemodialysis procedures patient’s condition improved, blood pressure was well controlled, anemia
and electrolyte disturbances improved, peripheral edemas and total body mass significantly decreased.
After broad-spectrum treatment patient was discharged home in good condition. Hypotensive and antiretroviral
treatment together with kidney replacement therapy have been continued.
Keywords: human immunodeficiency virusHIV-associated nephropathyhemodialysisnephrologyinfective diseases
References
- Rao TK, Filippone EJ, Nicastri AD, et al. Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome. N Engl J Med. 1984; 310(11): 669–673.
- Medapalli RK, He JC, Klotman PE. HIV-associated nephropathy: pathogenesis. Curr Opin Nephrol Hypertens. 2011; 20(3): 306–311.
- Atta MG, Choi MJ, Longenecker JC, et al. Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy. Am J Med. 2005; 118(11): 1288.
- Atta MG, Estrella MM, Skorecki KL, et al. Association of APOL1 Genotype with Renal Histology among Black HIV-Positive Patients Undergoing Kidney Biopsy. Clin J Am Soc Nephrol. 2016; 11(2): 262–270.
- Wyatt CM. Kidney disease and HIV infection. Top antivir med. 2017 Feb/Mar;25(1):13-16. .
- Reghine ÉL, Foresto RD, Kirsztajn GM. HIV-related nephropathy: new aspects of an old paradigm. Rev Assoc Med Bras (1992). 2020; 66Suppl 1(Suppl 1): s75–s81.
- Rivera FB, Ansay MF, Golbin JM, et al. HIV-Associated Nephropathy in 2022. Glomerular Dis. 2023; 3(1): 1–11.
- da Silva DR, Gluz IC, Kurz J, et al. Multiple facets of HIV-associated renal disease. Braz J Med Biol Res. 2016; 49(4): e5176.
- Palau L, Menez S, Rodriguez-Sanchez J, et al. HIV-associated nephropathy: links, risks and management. HIV AIDS (Auckl). 2018; 10: 73–81.
- Ndlovu KCZ, Sibanda W, Assounga A. Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study. BMC Nephrol. 2017; 18(1): 48.
- Ross MJ, Klotman PE. HIV-associated nephropathy. AIDS. 2004; 18(8): 1089–1099.
- Bertoldi A, De Crignis E, Miserocchi A et al. HIV and kidney: a dangerous liaison. New Microbiol. 2017 Jan;40(1):1-10. .
- Foy M, Estrella M, Lucas G, et al. Comparison of risk factors and outcomes in HIV immune complex kidney disease and hiv-associated nephropathy. Clin J Am Soc Nephrol. 2013; 8(9): 1524–1532.
- Adnani H, Agrawal N, Khatri A, et al. Impact of Antiretroviral Therapy on Kidney Disease in HIV Infected Individuals – A Qualitative Systematic Review. J Int Assoc Provid AIDS Care. 2022; 21.
- Ahmed S, Siddiqui RK, Siddiqui AK, et al. HIV associated thrombotic microangiopathy. Postgrad Med J. 2002; 78(923): 520–525.
- Becker S, Fusco G, Fusco J, et al. Collaborations in HIV Outcomes Research/US Cohort. HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: an observational study. Clin Infect Dis. 2004; 39 Suppl 5: S267–S275.
- Dineshkumar T, Dhanapriya J, Jaganathan P, et al. Thrombotic microangiopathy as an initial manifestation in HIV patients. Indian J Crit Care Med. 2016; 20(6): 374–376.
- Reghine ÉL, Foresto RD, Kirsztajn GM. HIV-related nephropathy: new aspects of an old paradigm. Rev Assoc Med Bras (1992). 2020; 66Suppl 1(Suppl 1): s75–s81.
- Palau L, Menez S, Rodriguez-Sanchez J, et al. HIV-associated nephropathy: links, risks and management. HIV AIDS (Auckl). 2018; 10: 73–81.
- Wohl D, Oka S, Clumeck N, et al. GS-US-2,92-01040111 and Study Team. Brief Report: A Randomized, Double-Blind Comparison of Tenofovir Alafenamide Versus Tenofovir Disoproxil Fumarate, Each Coformulated With Elvitegravir, Cobicistat, and Emtricitabine for Initial HIV-1 Treatment: Week 96 Results. J Acquir Immune Defic Syndr. 2016; 72(1): 58–64.
- Naicker S, Rahmanian S, Kopp JB. HIV and chronic kidney disease. Clin Nephrol. 2015; 83(7 Suppl 1): 32–38.
- Calza L. Renal toxicity associated with antiretroviral therapy. HIV Clin Trials. 2012; 13(4): 189–211.
- Ahuja TS, Collinge N, Grady J, et al. Is dialysis modality a factor in survival of patients with ESRD and HIV-associated nephropathy? Am J Kidney Dis. 2003; 41(5): 1060–1064.