Membranous nephropathy in patients with HIV: a report of 11 cases

Abstract

Background Membranous nephropathy (MN) has been recognized to occur in patients with human immunodeficiency virus (HIV) infection since the beginning of the HIV epidemic. The prevalence of phospholipase A2 receptor (PLA2R)-associated MN in this group has not been well studied. Methods We conducted a retrospective review of electronic pathology databases at three institutions to identify patients with MN and known HIV at the time of renal biopsy. Patients with comorbidities and coinfections known to be independently associated with MN were excluded. Results We identified 11 HIV-positive patients with biopsy-confirmed MN meeting inclusion and exclusion criteria. Patient ages ranged from 39 to 66 years old, and 10 of 11 patients (91%) were male. The majority of patients presented with nephrotic-range proteinuria, were on anti-retroviral therapy at the time of biopsy and had low or undetectable HIV viral loads. Biopsies from 5 of 10 (50%) patients demonstrated capillary wall staining for PLA2R. Measurement of serum anti-PLA2R antibodies was performed in three patients, one of whom had positive anti-PLA2R antibody titers. Follow-up data was available on 10 of 11 patients (median length of follow-up: 44 months; range: 4–145 months). All patients were maintained on anti-retroviral therapy (ARV) and 5 patients (52%) received concomitant immunosuppressive regimens. Three patients developed end-stage renal disease (ESRD) during the follow-up period. Conclusions MN in the setting of HIV is often identified in the setting of an undetectable viral loads, and similar to other chronic viral infection-associated MNs, ~ 50% of cases demonstrate tissue reactivity with PLA2R antigen, which may be seen without corresponding anti-PLA2R serum antibodies.

NELL1-Positive HIV-Associated Lupus-Like Membranous Nephropathy with Spontaneous Remission

“…Given the finding of NELL1-positive glomerular immune deposits in this patient, an additional 4 cases of HIV-associated MN (previously reported in reference [3]) were stained for NELL1, one of which was positive, yielding a total of 2 of 5 tested HIV-associated MN which expressed NELL1. This additional NELL1-positive HIVassociated MN occurred in a similar context of a patient on ART with an undetectable HIV viral load but differed from the reported patient in that it lacked any glomerular staining for C1q, had IgG4 dominant immune deposits, and the deposits were diffusely distributed along subepithelial aspects of glomerular basement membranes without mesangial or subepithelial immune deposits.…”

“…3; online suppl. Material), although anti-PLA2R antibodies were not detectable in the patient's serum [3].…”

“…Approximately 50% of HIV-associated MN cases have tissue reactivity for PLA2R antigen [1,3], which is not always accompanied by detectable serum anti-PLA2R anti- bodies [3]. NELL1-positive MN has also been associated with malignancy [4], alpha-lipoic acid use [5][6][7], graft versus host disease after hematopoietic stem cell transplantation [8], and apparently primary MN [9,10].…”

Primary membranous glomerulonephritis with negative serum PLA2R in haemophilia A successfully managed with rituximab – case report and review of the literature

“…Several reported cases in in HIV associated MN have been described. Charu et al [ 22 ]. present a series of eleven patients with HIV associated membranous nephropathy of whom one patient with circulating serum PLA2R antibodies demonstrated a favourable response to rituximab.…”

Incidence and risk factors of extrahepatic manifestations in patients with chronic HCV and HCV/HIV infection

“…-развитие инсулинорезистентности [33,34]; -развитие атеросклероза [33,35]. Все вышеуказанные патогенетические нарушения описаны и при ВИЧ-инфекции [30,[36][37][38][39][40][41][42], что заставляет предполагать увеличение количества внепеченочных проявлений у ко-инфицированных ВГС/ВИЧ пациентов. Однако среди наших пациентов методом сравнения групп критерием c 2 не было выявлено статистически значимых различий по встречаемости той или иной патологии среди ко-инфицированных ВГС/ВИЧ пациентов в сравнении с моноинфицированными ВГС, за исключением ХБП, которая среди инфицированных ВГС/ВИЧ встречалась в 3 раза чаще (35% против 11%, c 2 =22,841, р<0,001).…”