65 Immunotactoid Glomerulopathy in an Incident HIV Patient

IMMUNOTACTOID GLOMERULOPATHY IN AN INCIDENT HIV PATIENT Guiselle Clark, Jose A. Morfin, Univeristy of Californina Davis, Sacramento CA, USA Immunotactoid Glomerulpathy is a rare cause of Nephrotic Syndrome. While most cases are deemed to be idopathic, a small percentage are associated with Chronic Lymphocytic Lymphoma (CLL) and B cell lymphomas, while others can be associated with HIV infection which have been reported in the literature. We present a case of a patient with an initial presentation of Nephrotic Syndrome related to presumed Idiopathic Immunotactoid Glomerulopathy who subsequently developed an AIDS defining illness with a favorable clinical response to HAART Therapy. 30 year old Native American, homeless gentleman with no known past medical history presented with worsening, progressive bilateral lower extremity swelling associated with brown appearing urine over a period of weeks to months. On admission, he was noted to have preserved kidney function, but nephrotic syndrome. Complete serological workup was unremarkable without an HIV test due to lack of consent. A renal biopsy demonstrated immune complex mediated glomerulopathy consistent with Immunotactoid Glomerulonephritis. No secondary causes were identified and due to his marginal housing, the patient was lost to follow up for the next 6 months, at which time, he re-presented with a pulmonary embolus and cryptococcus meningitis consistent with AIDS. Patient was initiated on HAART and anticoagulation without cytotoxic therapy. Over the next 12 months, he had significant improvement in clinical status. HIV has many associated immune complex glomerular diseases and as in this case, the nephrotic syndrome can be the initial presentation of an AIDS Defining Illness. Immunotactoid glomerulopathy is treated with caution when using cytotoxic therapy. The optimal therapy for immune complex glomerulonephritis in the setting of HIV infection is unknown, the role of antiretroviral therapy in modifying the course of these renal lesions appears to be promising as illustrated in this case.