Abstract
There are various forms of renal lesions in patients with human immunodeficiency virus (HIV), however reported cases of immunecomplex glomerulonephritis are scarce . Here we describe an HIVpositive patient with Henoch-Schonlein purpura nephritis (HSPN), which presented as nephrotic syndrome. In addition to therapy combined with glucocorticosteroid and inhibition of the renin-angiotesin system (RAS), plasmapheresis and antiretroviral therapy produced a favorable outcome. A 26-year-old HIV positive man was admitted for purpura on both lower limbs. Despite glucocor ticosteroid treatment, purpura recurred and urinary protein increased to 5-10 g daily . HSPN was diagnosed based on the skin and renal biopsies. During 2 months of treatment with combined glucocor ticosteroid and RAS inhibition, nephrotic syndrome persisted . He received double filtration plasmapheresis (DFPP) . Soon after, urine protein decreased to 2-3 g daily and macrohematuria decreased . The second renal biopsy showed a decrease in IgA deposition and improvement of acute inflammatory changes. In addition, highly active antiretroviral therapy was started to reduce the high viral load . After 3 weeks, HIV-l-RNA rapidly decreased and urine protein decreased to I g daily . After a year, urinary protein was negative, but mild macrohematuria persisted. We speculate that the refractory nephrotic syndrome in this patient might be associated with the abnormal immunological condition due to HIV infection.
