• Kirk M Chan-Tack, Navneet Ahuja, Edward J Weinman, Ravinder K Wali, Anayochukwu Uche, Lisa A Greisman, Cinthia Drachenberg, Philip N Hawkins, and Robert R Redfield.
• Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. kchan@medicine.umaryland.edu
• Am. J. Med. Sci. 2006 Dec 1; 332 (6): 364-7.

AbstractAmyloidosis is an uncommon cause of renal disease in HIV-positive patients. Diagnosis is challenging, treatment options are limited, and prognosis remains poor. We discuss an HIV-positive patient with acute renal failure and nephrotic range proteinuria. The differential diagnosis included nephropathy due to trimethoprim/sulfamethoxazole, tenofovir, HIV, hepatitis C, heroin, or multifactorial causes. Serum and urine study findings were inconclusive. Rapid clinical deterioration ensued and a renal biopsy was performed. Pathologic examination revealed eosinophilic, amorphous material in the glomerular tufts that stained red-orange with Congo red stain. Immunohistochemical analysis confirmed amyloid A (AA) amyloidosis. AA amyloidosis occurs as a complication of chronic infection or chronic inflammatory disease. It has been reported in intravenous or subcutaneous drug abusers, some of whom were HIV-positive. This case underscores the importance of tissue diagnosis to determine the cause of renal disease in HIV-positive patients. Clinical diagnosis, based on CD4 count, viral load, and degree of proteinuria, may not predict the pathological diagnosis in HIV-positive patients.

15 keywords...

hide…