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    "textoCompleto" => "To the editor&#58; Collapsing focal glomerulonephritis &#40;CFG&#41; is found in 2-10&#37; of all HIV-infected patients&#46;1 It is the most common form of renal disease in HIV patients&#44; appearing in over 60&#37; of the renal biopsies made&#46;2 The presence of proteinuria and&#47;or impaired renal function are associated with increased patient morbidity-mortality&#46;3 The management of nephropathy associated to HIV infection &#40;NAHIV&#41; has not been established&#44; and most patients require renal replacement treatment a few months after the appearance of nephrotic syndrome&#46;4 <br></br><br></br>A 41-year-old black male with type 1 HIV infection not subjected to antiretroviral therapy was admitted with generalized edema and proteinuria in the nephrotic range&#46; Upon admission&#44; the blood pressure was 140&#47;90 mmHg&#44; <br></br>and edema with fovea was seen to ankle level&#46; The laboratory tests showed normocytic and normochromic anemia with an erythrocyte sedimentation rate of 157 mm in the first hour&#44; normal kidney function &#40;plasma creatinine 1&#46;1 mg&#47;dl and plasma clearance calculated by the MDRD equation 78&#46;41 ml&#47;min&#41;&#44; proteinuria 5&#46;83 g&#47;day without Bence-Jones proteinuria&#44; plasma albumin 1&#46;6 g &#47;dl with polyclonal band in gamma region 7&#46;7 g&#47;dl &#40;IgG 9860 mg&#47;dl&#44; IgA 151 mg&#47;dl&#44; IgM 643 mg&#47;dl&#41;&#44; and a CD4&#43; count of 314 cells&#47;mm3&#46; HBV&#44; HCV and herpes group serology proved negative&#46; A myelogram revealed reactive plasmacytosis&#44; while a bone cylinder specimen showed intense polyclonal <br></br>lymphoplasmacytosis&#46; Renal ultrasound showed symmetrical kidney enlargement&#44; with preserved corticomedullary <br></br>differentiation but with a diffuse increase in echogenicity&#46; The Doppler study proved normal&#46; The kidney biopsy revealed collapsing glomerulopathy with preserved tubules and an interstitial lymphocytic and polyclonal infiltrate&#46; Antiretroviral treatment was started with efavirenz&#44; stavudine and lamivudine&#44; together with furosemide and enalapril&#46; At discharge the blood pressure was 130&#47;80&#44; with proteinuria 300 mg&#47;day&#46; The patient posteriorly returned to his country of origin and reappeared 14 months later&#44; without any reported opportunistic processes or nephrotic manifestations&#46; While in his country&#44; the patient continued treatment with enalapril and started nevirapine&#44; zidovudine as lamivudine as antiretroviral therapy&#46; The patient was found to have normal blood pressure&#44; with no edemas&#44; and showed normocytic and normochromic anemia&#44; with normal kidney function &#40;plasma creatinine 0&#46;98 ml&#47;dl&#41;&#44; proteinuria 3 g&#47;day and plasma albumin 2&#46;6 g&#47;dl&#46; The CD4&#43; count was 350 cells&#47;mm3&#46; <br></br><br></br>Collapsing focal glomerulonephritis &#40;CFG&#41; is found in 2-10&#37; of all HIV-infected patients&#44;1 and is the most common form of kidney involvement in black HIV-infected individuals&#46;2&#44;6&#44;7 CFG is characterized by glomerular collapse and severe tubulointerstitial alterations&#46; The underlying pathogenesis appears to be related to viral infection &#191; HIV infection being the most common example&#46; NAHIV is characterized by proteinuria in the nephrotic range&#44; with rapid deterioration of renal function&#46; In this context&#44; proteinuria and increased plasma creatinine are regarded as indicative of a poor prognosis&#46;3 At present there is no effective treatment for NAHIV&#44; and most patients require renal replacement therapy on a chronic basis&#46;4 Some studies suggest that treatment with antiproteinuric agents and highly active antiretroviral therapy &#40;HAART&#41; can delay the progression of renal failure8 and even reduce the incidence of NAHIV5 &#191; emphasis being placed on the importance of an early biopsy in these patients&#46;5 In our case it can be affirmed that combined HAART and angiotensin-converting enzyme inhibitor &#40;ACEI&#41; treatment avoided the <br></br>deterioration of renal function&#44; reducing proteinuria and resolving the nephrotic syndrome&#44; in a black patient with NAHIV&#46; "
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        "resumen" => "Sr Director&#58; La glomerulonefritis focal colapsante &#40;GFC&#41; ocurre en un 2-10&#37; de los pacientes portadores del VIH&#40;1&#41;&#46; Es la forma m&#225;s frecuente de afectaci&#243;n renal en los pacientes VIH&#44; apareciendo en m&#225;s del 60&#37; de las biopsias renales realizadas&#40;2&#41;&#46; La presencia de proteinuria y&#47;o el deterioro de la funci&#243;n renal se asocian con un incremento en la morbimortalidad&#40;3&#41;&#46; El tratamiento de la nefropat&#237;a asociada a VIH &#40;NAVIH&#41; no est&#225; establecido y la mayor&#237;a de los pacientes precisan tratamiento sustitutivo renal pocos meses despu&#233;s del inicio del s&#237;ndrome nefr&#243;tico&#40;4&#41;&#46; "
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HIV-associated nephropathy without decline of renal function
Nefropatía asociada a VIH sin deterioro de función renal
Rosalia Valeroa, Emilio Rodrigoa, Celestino Piñeraa, Manuel Ariasa
a Servicio de Nefrología, Hospital Universitario Marqués de Valdeiclla España,
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    "textoCompleto" => "To the editor&#58; Collapsing focal glomerulonephritis &#40;CFG&#41; is found in 2-10&#37; of all HIV-infected patients&#46;1 It is the most common form of renal disease in HIV patients&#44; appearing in over 60&#37; of the renal biopsies made&#46;2 The presence of proteinuria and&#47;or impaired renal function are associated with increased patient morbidity-mortality&#46;3 The management of nephropathy associated to HIV infection &#40;NAHIV&#41; has not been established&#44; and most patients require renal replacement treatment a few months after the appearance of nephrotic syndrome&#46;4 <br></br><br></br>A 41-year-old black male with type 1 HIV infection not subjected to antiretroviral therapy was admitted with generalized edema and proteinuria in the nephrotic range&#46; Upon admission&#44; the blood pressure was 140&#47;90 mmHg&#44; <br></br>and edema with fovea was seen to ankle level&#46; The laboratory tests showed normocytic and normochromic anemia with an erythrocyte sedimentation rate of 157 mm in the first hour&#44; normal kidney function &#40;plasma creatinine 1&#46;1 mg&#47;dl and plasma clearance calculated by the MDRD equation 78&#46;41 ml&#47;min&#41;&#44; proteinuria 5&#46;83 g&#47;day without Bence-Jones proteinuria&#44; plasma albumin 1&#46;6 g &#47;dl with polyclonal band in gamma region 7&#46;7 g&#47;dl &#40;IgG 9860 mg&#47;dl&#44; IgA 151 mg&#47;dl&#44; IgM 643 mg&#47;dl&#41;&#44; and a CD4&#43; count of 314 cells&#47;mm3&#46; HBV&#44; HCV and herpes group serology proved negative&#46; A myelogram revealed reactive plasmacytosis&#44; while a bone cylinder specimen showed intense polyclonal <br></br>lymphoplasmacytosis&#46; Renal ultrasound showed symmetrical kidney enlargement&#44; with preserved corticomedullary <br></br>differentiation but with a diffuse increase in echogenicity&#46; The Doppler study proved normal&#46; The kidney biopsy revealed collapsing glomerulopathy with preserved tubules and an interstitial lymphocytic and polyclonal infiltrate&#46; Antiretroviral treatment was started with efavirenz&#44; stavudine and lamivudine&#44; together with furosemide and enalapril&#46; At discharge the blood pressure was 130&#47;80&#44; with proteinuria 300 mg&#47;day&#46; The patient posteriorly returned to his country of origin and reappeared 14 months later&#44; without any reported opportunistic processes or nephrotic manifestations&#46; While in his country&#44; the patient continued treatment with enalapril and started nevirapine&#44; zidovudine as lamivudine as antiretroviral therapy&#46; The patient was found to have normal blood pressure&#44; with no edemas&#44; and showed normocytic and normochromic anemia&#44; with normal kidney function &#40;plasma creatinine 0&#46;98 ml&#47;dl&#41;&#44; proteinuria 3 g&#47;day and plasma albumin 2&#46;6 g&#47;dl&#46; The CD4&#43; count was 350 cells&#47;mm3&#46; <br></br><br></br>Collapsing focal glomerulonephritis &#40;CFG&#41; is found in 2-10&#37; of all HIV-infected patients&#44;1 and is the most common form of kidney involvement in black HIV-infected individuals&#46;2&#44;6&#44;7 CFG is characterized by glomerular collapse and severe tubulointerstitial alterations&#46; The underlying pathogenesis appears to be related to viral infection &#191; HIV infection being the most common example&#46; NAHIV is characterized by proteinuria in the nephrotic range&#44; with rapid deterioration of renal function&#46; In this context&#44; proteinuria and increased plasma creatinine are regarded as indicative of a poor prognosis&#46;3 At present there is no effective treatment for NAHIV&#44; and most patients require renal replacement therapy on a chronic basis&#46;4 Some studies suggest that treatment with antiproteinuric agents and highly active antiretroviral therapy &#40;HAART&#41; can delay the progression of renal failure8 and even reduce the incidence of NAHIV5 &#191; emphasis being placed on the importance of an early biopsy in these patients&#46;5 In our case it can be affirmed that combined HAART and angiotensin-converting enzyme inhibitor &#40;ACEI&#41; treatment avoided the <br></br>deterioration of renal function&#44; reducing proteinuria and resolving the nephrotic syndrome&#44; in a black patient with NAHIV&#46; "
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        "resumen" => "Sr Director&#58; La glomerulonefritis focal colapsante &#40;GFC&#41; ocurre en un 2-10&#37; de los pacientes portadores del VIH&#40;1&#41;&#46; Es la forma m&#225;s frecuente de afectaci&#243;n renal en los pacientes VIH&#44; apareciendo en m&#225;s del 60&#37; de las biopsias renales realizadas&#40;2&#41;&#46; La presencia de proteinuria y&#47;o el deterioro de la funci&#243;n renal se asocian con un incremento en la morbimortalidad&#40;3&#41;&#46; El tratamiento de la nefropat&#237;a asociada a VIH &#40;NAVIH&#41; no est&#225; establecido y la mayor&#237;a de los pacientes precisan tratamiento sustitutivo renal pocos meses despu&#233;s del inicio del s&#237;ndrome nefr&#243;tico&#40;4&#41;&#46; "
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Article information
ISSN: 20132514
Original language: English
DOI:
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