Introduction. The most commonly seen glomerular disease in HIV infected patients is
HIV-associated nephropathy (HIVAN); however, a multitude of other nephropathies can occur in
HIV infection with an almost equal cumulative frequency. We report an unusual case of a patient with clinical and histological evidence of HIVAN in which the diagnosis was initially confounded by the finding of an elevated serum anti-glomerular basement membrane (
anti-GBM) antibody. Case Presentation. We present a case of a 27-year-old African American female with a history of
schizophrenia,
cocaine abuse, and
HIV infection who upon admission to our hospital was found to have severe
acute kidney injury requiring
hemodialysis. Urine studies revealed nephrotic range
proteinuria and a serological workup was positive for
anti-GBM antibody elevation with a value of 91 units (normal: 0-20 units). A renal biopsy revealed HIVAN with no evidence of crescentic
glomerulonephritis or
anti-GBM disease. Conclusion. This case highlights the need for careful interpretation of
anti-GBM antibody tests in HIV infected patients with
kidney disease and, in particular, the need for biopsy confirmation of the diagnosis prior to starting
therapy. More research is needed to study the prognostic correlation between the degree of
anti-GBM antibody elevation in HIVAN and disease severity.