Twenty consecutive HIV-infected adults with biopsy-proven HIV-AN (n = 17) or clinical characteristics of HIV-AN (n = 3) with serum
creatinine concentrations > 177 mumol/L (2 mg/dL) or
proteinuria > 2.0 g/d or both were prospectively evaluated and treated with
prednisone at a dose of 60 mg/d for 2 to 11 weeks, followed by a tapering course of
prednisone over a 2- to 26-week period. Serum
creatinine concentration, 24-hour
protein excretion,
serum albumin, and
steroid-related adverse effects were assessed before and
after treatment.
RESULTS: Nineteen patients had serum
creatinine concentrations > 117 mumol/L (2 mg/dL). Two of them progressed to
end stage renal disease (
ESRD) in 4 to 5 weeks. In 17 patients serum
creatinine levels decreased from 717 +/- 103 mumol/L (8.1 +/- mg/dL) (mean +/- SE) to 262 +/- 31 mumol/L (3.0 +/- 0.4 mg/dL) (P < 0.001). Five patients relapsed after
prednisone was discontinued and were retreated. In these 5 the serum
creatinine declined from 728 +/- 107 mumol/L (8.2 +/- 1.2 mg/dL) to 344 +/- 47 mumol/L (3.9 +/- 0.5 mg/dL) (P < 0.01) in response to the second course of
prednisone. Twelve of 13 tested patients showed a reduction in 24-hour urinary
protein excretion with an average decrement from 9.1 +/- 1.8 g/d to 3.2 +/- 0.6 g/d (P < 0.005).
Serum albumin increased from 24.4 +/- 3.6 g/L to 29.3 +/- 2.6 g/L (P = NS) in the 11 patients with paired 24-hour urine collections for whom pre- and post-treatment determinations were available. In one non-azotemic patient with
nephrotic syndrome,
protein excretion declined from 15.2 to 2.2 g/day and the
serum albumin increased from 4.0 g/L to 31.0 g/L. The 20 patients have been followed for a median of 44 weeks (range 8 to 107). Eight ultimately required maintenance dialysis. Eleven died from complications of HIV disease 14 to 107 weeks after institution of
prednisone; none was receiving
prednisone at the time of death. Seven are alive and free from
ESRD a median of 25 weeks (range 8 to 81) from the initiation of
prednisone therapy. Six patients developed a total of seven serious
infections while receiving
prednisone, including Mycobacterium avium-complex
infection in 2 and CMV
retinitis in 3.
CONCLUSION: