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Portuguese Journal of Nephrology & Hypertension

Print version ISSN 0872-0169


COELHO, Sofia et al. Amyloidosis related to HIV - An unusual cause of nephrotic syndrome in HIV patients. Port J Nephrol Hypert [online]. 2017, vol.31, n.3, pp.207-211. ISSN 0872-0169.

Human immunodeficiency virus infection is a multisystemic disease which causes kidney disease in a variable proportion of infected patients. AA amyloidosis, in turn, is an unusual complication related to HIV infection and also an infrequent cause of kidney disease; in this setting AA amyloidosis usually results from chronic skin infections related to intravenous use of recreational drugs. We report the case of a 43-year-old woman, native of the Ivory Coast, with active HIV 1 infection diagnosed 11 years ago, currently in the Centers for Disease Control and Prevention’s stage C3, out of antiretroviral therapy for non-adherence and with persistent positive viral load, admitted to the nephrology department for nephrotic syndrome. The patient denied any other relevant clinical history, including chronic or recurrent inflammatory or infectious disease or use or abuse of recreational drugs. Urine sediment and renal function were both normal as was renal ultrasound. Other opportunistic infections were excluded. The renal biopsy revealed deposition of amorphous substance, Congo red positive, in the vascular walls and a positive immunofluorescence for serum amyloid A, confirming the diagnosis of renal amyloidosis. The patient was started on antiretroviral and symptomatic therapy, with clinical improvement. The clinical diagnosis of renal amyloidosis secondary to HIV can be challenging, as it requires the exclusion of other possible aetiologies, but should be considered in the differential diagnosis of renal disease in HIV patients. This case illustrates the importance of the renal biopsy in such cases in which the diagnosis can be improperly set up if based only on clinical data.

Keywords : AA amyloidosis; antiretroviral therapy; human immunodeficiency virus infection; nephrotic syndrome; renal biopsy.

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