Treatment of renal AA-Amyloidosis associated with human immunodeficiency virus infection: a case report
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CASE REPORT
Treatment of renal AA‑Amyloidosis associated with human immunodeficiency virus infection: a case report Janice Borg1 · Jesmar Buttigieg2 · Stephen Holwill3 · Charles Mallia Azzopardi4 Received: 1 July 2020 / Accepted: 25 August 2020 © Japanese Society of Nephrology 2020
Abstract We present a case of a young adult male who was treated successfully for renal AA-amyloidosis secondary to human immunodeficiency virus (HIV) infection using highly active anti-retroviral therapy (HAART). He presented with lobar pneumonia, acute kidney injury, nephrotic syndrome and newly diagnosed HIV infection and was initiated on HARRT and haemodialysis. Kidney biopsy was consistent with amyloid deposition of the AA-type. His clinical condition improved gradually and after 10 months of therapy, he regained sufficient excretory function to become dialysis independent. Two years later, he remained well, with a recovered CD4 count and a glomerular filtration rate of 63 mL/min/1.73 m2. Patients with renal AA-amyloidosis typically present with slowly progressive chronic kidney disease, often leading to end-stage kidney disease within months. To our knowledge, this is the first reported case of biopsy proven renal AA-amyloidosis in a newly diagnosed HIV positive patient to present with acute kidney injury leading to dialysis dependence over a period of 2 weeks, which was successfully treated using HAART. Keywords Haemodialysis · Chronic kidney disease · Renal biopsy · Nephrotic syndrome
Introduction AA-amyloidosis is a systemic disease whose clinical course is characteristically dominated by the renal dysfunction [1]. Patients typically present with nephrotic range proteinuria, nephrotic syndrome and slowly progressive chronic kidney disease (CKD), frequently leading to end-stage kidney disease (ESKD) [2]. Left untreated, AA-amyloidosis carries a rather poor prognosis, especially in patients who progress to ESKD. We present a case of HIV related renal AA-amyloidosis in a patient with no other co-morbidities or risk factors, presenting with nephrotic syndrome and rapidly progressive renal dysfunction, becoming dialysis dependent in a * Janice Borg [email protected] 1
Depatment of Medicine, Mater Dei Hospital, Triq Dun Karm, Msida MSD 2090, Malta
2
Renal Division, Mater Dei Hospital, Triq Dun Karm, Msida MSD 2090, Malta
3
Histopathology, Musgrove Park Hospital, Parkfield Dr, Taunton TA1 5DA, UK
4
Infectious Diseases Unit, Mater Dei Hospital, Triq Dun Karm, Msida MSD 2090, Malta
matter of 2 weeks. The patient was successfully treated with HAART, allowing him to come off dialysis after 10 months of therapy. In addition, this case highlights the complexity and challenging diagnosis of renal disease in HIV infected patients, with renal biopsy being of utmost importance for accurate diagnosis and management.
Case history A 39-year-old male from Liberia presented with a cough productive of blood tinged sputum, left sided pleurisy and lower limb swelling. The swelling had been present for a few weeks, but the coug
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