Acute tubular nephropathy in a patient with acute HIV infection: review of the literature

Jintanat Ananworanich; Anandita A Datta; James Lk Fletcher; Natavudh Townamchai; Nitiya Chomchey; Eugene Kroon; Irini Sereti; Victor Valcour; Jerome H Kim

doi:10.1186/1742-6405-11-34

Acute tubular nephropathy in a patient with acute HIV infection: review of the literature

AIDS Res Ther. 2014 Nov 7:11:34. doi: 10.1186/1742-6405-11-34. eCollection 2014.

Authors

Jintanat Ananworanich¹, Anandita A Datta², James Lk Fletcher³, Natavudh Townamchai⁴, Nitiya Chomchey³, Eugene Kroon³, Irini Sereti⁵, Victor Valcour⁶, Jerome H Kim⁷

Affiliations

¹ SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand ; Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV, Pathumwan, Bangkok 10330 Thailand ; US Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA ; US Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD 20817 USA.
² Division of Nephropathology, Joint Pathology Center, 606 Stephen Sitter Avenue, Silver Spring, MD 20910 USA.
³ SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
⁴ Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV, Pathumwan, Bangkok 10330 Thailand.
⁵ Clinical and Molecular Retrovirology Section/ Laboratory of Immunoregulation, 10 Center Drive, building 10, room 11B-07A, Bethesda, MD 20892 USA.
⁶ Memory and Aging Center, University of California at San Francisco, Suite 905, 350 Parnassus Avenue, San Francisco, CA 94143 USA.
⁷ US Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA.

Abstract

We report a 57-year old man with diabetes mellitus and hypertension who presented with acute HIV infection. Routine blood tests showed an elevated blood urea nitrogen and creatinine. Renal biopsy showed acute tubular nephropathy, which has not been reported to occur during acute HIV infection, in the absence of rhabdomyolysis or multiple organ system failure. Antiretroviral therapy was initiated. His renal failure gradually resolved without further intervention. At one year of follow-up his HIV RNA was undetectable, and his renal function was normal. The case illustrates a rare manifestation of acute HIV infection - acute renal failure - in an older man with diabetes and hypertension. In this setting acute kidney injury might mistakenly have been attributed to his chronic comorbidities, and this case supports early HIV-1 testing in the setting of a high index of suspicion.

Keywords: Acute HIV infection; Acute renal failure; Acute retroviral syndrome; Acute tubular nephropathy; Elderly; HIV.