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

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.