Hidayani Saragih Restuti, Syafrizal Nasution, Jamaluddin Pane, Ong Jaya Fandy
Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Adam Malik General Hospital, Medan, Indonesia.
Afr J Infect Dis. 2024 Oct 25;19(1):79-83. doi: 10.21010/Ajidv19i1.9. eCollection 2025.
Various glomerular diseases are associated with human immunodeficiency virus (HIV) infection. However, the incidence of minimal change nephrotic syndrome has scarcely been reported.
We describe a patient with a stage 4 HIV infection complaining of swelling in his face, hands, feet, genitals and an enlarged abdomen. Urinalysis revealed +3 proteins with normal urine sediment, and 2.1 g protein was found in the 24-hour analysis. Renal ultrasound showed bilateral glomerulopathies with hyperechoic and cortical thickening, a normal kidney size, and ascites. Kidney biopsy revealed acute tubular injury without HIV-associated nephropathy (HIVAN) features. The patient was treated with salt restriction, diuretics, captopril, methylprednisolone, and combined ART for 2 weeks and showed clinical improvement.
Two weeks after the remission, the patient came to the outpatient department with a history of a 3-day cough with rust-colored sputum, fever, malaise, and shortness of breath. The lung auscultation revealed bilateral rhonchi and the chest x-ray result suggesting pneumonia. The patient was diagnosed with sepsis associated with healthcare-associated pneumonia but was not willing to be hospitalized and passed away at home. This study is limited to single-case nature and the possibility of sampling error.
However, this case encourages further study in the field of HIV-associated renal diseases in providing clear recommendation in the management in special population.
多种肾小球疾病与人类免疫缺陷病毒（HIV）感染相关。然而，微小病变肾病综合征的发病率鲜有报道。
我们描述了一名处于HIV感染4期的患者，其主诉面部、手部、足部、生殖器肿胀及腹部增大。尿液分析显示尿蛋白3+，尿沉渣正常，24小时尿蛋白定量为2.1g。肾脏超声显示双侧肾小球病变，回声增强及皮质增厚，肾脏大小正常，伴有腹水。肾活检显示急性肾小管损伤，无HIV相关性肾病（HIVAN）特征。该患者接受限盐、利尿剂、卡托普利、甲泼尼龙治疗，并联合抗逆转录病毒治疗2周，临床症状改善。
缓解2周后，该患者前往门诊，有3天咳嗽伴铁锈色痰、发热、乏力及气短病史。肺部听诊显示双侧啰音，胸部X线结果提示肺炎。该患者被诊断为与医疗保健相关肺炎相关的脓毒症，但不愿住院，在家中去世。本研究限于单病例性质及存在抽样误差的可能性。
然而，该病例鼓励在HIV相关性肾脏疾病领域进行进一步研究，以便为特殊人群的管理提供明确建议。
