Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center of Child and Adolescent Health, University Duesseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
Pediatr Nephrol. 2012 Apr;27(4):667-9. doi: 10.1007/s00467-011-2069-5. Epub 2011 Dec 29.
Up to 50% of patients with severe immune deficiency experience an excessive inflammatory response called immune reconstitution inflammatory syndrome (IRIS) after the initiation of antiretroviral therapy (ART). IRIS has been observed after various opportunistic infections with pathogens such as mycobacteria, including Bacille Calmette-Guérin, cryptococci, human herpesvirus-8, non-Hodgkin's lymphoma, and progressive multifocal leukoencephalopathy. Non-acquired immune deficiency-defining illnesses can also deteriorate after commencement of ART. Renal IRIS has been reported in a few patients with mycobacterial infections, but to the best of our knowledge no cases of nephrotic syndrome and IRIS have been described.
CASE-DIAGNOSIS/TREATMENT: We report the case of an infant with human immunodeficiency virus-1 (HIV-1) infection, Pneumocystis pneumonia, and encephalopathy. During immune reconstitution the patient developed nephrotic syndrome. Treatment of nephrotic syndrome was initiated with prednisone, an angiotensin-converting enzyme inhibitor (lisinopril), and low-molecular-weight heparin. ART was continued, but only a low level of lopinavir/ritonavir could be achieved. There was no relapse of nephrotic syndrome during 10 months of follow-up.
Nephrotic syndrome may occur in infants during immune reconstitution and should not be overlooked.
多达 50%的严重免疫缺陷患者在开始抗逆转录病毒治疗 (ART) 后会出现一种称为免疫重建炎症综合征 (IRIS) 的过度炎症反应。在各种机会性感染（如分枝杆菌、隐球菌、人类疱疹病毒-8、非霍奇金淋巴瘤和进行性多灶性白质脑病）后，已经观察到 IRIS。非获得性免疫缺陷定义疾病在开始 ART 后也可能恶化。已经有少数分枝杆菌感染患者报告了肾 IRIS，但据我们所知，尚无肾病综合征和 IRIS 的病例描述。
病例诊断/治疗：我们报告了一例人类免疫缺陷病毒-1 (HIV-1) 感染、卡氏肺孢子虫肺炎和脑病的婴儿病例。在免疫重建过程中，患者出现肾病综合征。肾病综合征的治疗采用泼尼松、血管紧张素转换酶抑制剂（赖诺普利）和低分子量肝素。继续进行 ART，但仅能达到低水平的洛匹那韦/利托那韦。在 10 个月的随访中，肾病综合征没有复发。
肾病综合征可能在婴儿免疫重建期间发生，不应被忽视。
