Acute renal failure associated with immune restoration inflammatory syndrome.

Abstract

BACKGROUND:

A 30-year-old HIV-infected woman presented with fever and abdominal pain 4 days after initiation of highly active antiretroviral therapy (HAART), and 1 month after initiation of antimicrobial therapy for Mycobacterium tuberculosis infection. A diagnosis of immune restoration inflammatory syndrome (IRIS) was considered, and corticosteroids were started. Steroid therapy doses were progressively tapered, during which time the patient developed renal failure with enlarged kidneys. A renal biopsy showed acute interstitial nephritis. Extensive investigations failed to detect active infection. The efficacy of HAART was attested by increased CD4+ cell counts and undetectable viral replication.

INVESTIGATIONS:

Physical examination, plasma viral load and CD4+ cell count, abdominal and renal ultrasound, renal and peritoneal biopsies, renal and liver function, chest X-ray, and bronchoalveolar lavage culture.

DIAGNOSIS:

Acute renal failure secondary to IRIS.

MANAGEMENT:

Prednisone therapy.

• Authors: Eric Daugas, Emmanuelle Plaisier, Jean-Jacques Boffa, Jean-Baptiste Guiard-Schmid, Jerôme Pacanowski, Béatrice Mougenot, Pierre Ronco
• Journal: Nature clinical practice. Nephrology (Nat Clin Pract Nephrol) Vol. 2 Issue 10 Pg. 594-8; quiz 599 (Oct 2006) ISSN: 1745-8323 [Print] England
• PMID: 17003838 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Prednisone

Topics

• Acute Kidney Injury (drug therapy, immunology, pathology, physiopathology)
• Adult
• Anti-Inflammatory Agents (pharmacology)
• Female
• Humans
• Immune System Diseases (physiopathology)
• Prednisone (pharmacology)