Case of human immunodeficiency virus infection presenting as a tip variant of focal segmental glomerulosclerosis: A case report and review of the literature

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.