Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Aug 7, 2018; 7(4): 90-95
Published online Aug 7, 2018. doi: 10.5527/wjn.v7.i4.90
Case of human immunodeficiency virus infection presenting as a tip variant of focal segmental glomerulosclerosis: A case report and review of the literature
Daiki Goto, Naro Ohashi, Asumi Takeda, Yoshihide Fujigaki, Akira Shimizu, Hideo Yasuda, Kazuhisa Ohishi
Daiki Goto, Naro Ohashi, Hideo Yasuda, Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Asumi Takeda, Kazuhisa Ohishi, Division of Nephrology, Hamamatsu Medical Center, Hamamatsu 432-8580, Japan
Yoshihide Fujigaki, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
Akira Shimizu, Department of Pathology, Nihon University School of Medicine, Tokyo 113-8602, Japan
Author contributions: All of the authors worked as clinicians for this patient; Goto T and Ohashi N wrote the paper; Fujigaki Y, Shimizu A and Yasuda H reviewed the manuscript.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naro Ohashi, MD, PhD, Assistant Professor, Doctor, Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu 431-3192, Japan. ohashi-n@hama-med.ac.jp
Telephone: +81-53-4352261 Fax: +81-53-4349447
Received: June 1, 2018
Peer-review started: June 1, 2018
First decision: June 5, 2018
Revised: June 28, 2018
Accepted: June 30, 2018
Article in press: June 30, 2018
Published online: August 7, 2018
Processing time: 67 Days and 17.7 Hours
Abstract

The incidence of the collapsing variant of focal segmental glomerulosclerosis (FSGS) as a human immunodeficiency virus (HIV)-associated nephropathy has reduced since the introduction of antiretroviral therapy (ART). However, the incidence of other variants of FSGS, except for the collapsing variant, is increasing, and its therapeutic strategies remain uncertain. A 60-year-old HIV infected man in remission with ART was admitted for progressive renal insufficiency and nephrotic-ranged proteinuria. Renal biopsy revealed a tip variant of FSGS and his clinical manifestations resolved with corticosteroid therapy. HIV infected patients might develop non-collapsing FSGS, including tip variant of FSGS and corticosteroid therapy might be effective for them. A renal biopsy might be essential to determine the renal histology and to decide on corticosteroid therapy.

Keywords: Focal segmental glomerulosclerosis; Tip variant; Antiretroviral therapy; Corticosteroid therapy; Human immunodeficiency virus

Core tip: Collapsing variant of focal segmental glomerulosclerosis (FSGS) is the most common kidney disease in human immunodeficiency virus (HIV) infected patients. However, the incidence has reduced since the introduction of antiretroviral therapy (ART). Although the incidence of other variants of FSGS, except for the collapsing variant, is increasing, the tip variant of FSGS has been rarely reported. Therefore, we report an HIV infected patient under remission with ART, who presented with a rare tip variant of FSGS, which resolved with corticosteroid therapy. We suggest a renal biopsy might be essential to determine the renal histology and to decide on corticosteroid therapy.