Goto D, Ohashi N, Takeda A, Fujigaki Y, Shimizu A, Yasuda H, Ohishi K. Case of human immunodeficiency virus infection presenting as a tip variant of focal segmental glomerulosclerosis: A case report and review of the literature. World J Nephrol 2018; 7(4): 90-95 [PMID: 30090707 DOI: 10.5527/wjn.v7.i4.90]
Corresponding Author of This Article
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
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
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, 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
ARTICLE HIGHLIGHTS
Case characteristics
We reported a human immunodeficiency virus (HIV) infected patient in remission with antiretroviral therapy (ART), who presented with a rare tip variant of focal segmental glomerulosclerosis (FSGS), which resolved with corticosteroid therapy.
Clinical diagnosis
We diagnosed the patient as a case of HIV infection presenting as a tip variant of FSGS.
Differential diagnosis
HIV-associated nephropathy (HIVAN) or other causes of FSGS have to be differentiated because therapeutic strategies (ART or steroids) are different.
Laboratory diagnosis
Whether HIV RNA levels are positive or negative are important.
Pathological diagnosis
Tip variant of FSGS is needed to diagnose that more than one glomerulus show epithelial hypercellularity at the tubular pole, where a confluence of the tubular cells at the tubular outlet is observed in renal biopsy specimen.
Treatment
Steroid therapy is considered to administer to other causes of FSGS except for HIVAN including the tip variant.
Related reports
Lescure et al is important for the readers to understand the changes of HIV-associated kidney glomerular diseases with time and ART.
Term explanation
Tip variant is one of the diagnoses in the Columbia classification of FSGS and is explained as follows: More than one glomerulus shows epithelial hypercellularity at the tubular pole, where a confluence of the tubular cells at the tubular outlet is observed in renal biopsy.
Experiences and lessons
When renal damage is caused in HIV-infected patients, a renal biopsy may be essential to determine the renal histology and to decide on corticosteroid therapy.
