An An Intriguing Case of Rapidly Progressive Renal Failure in an Acquired Immunodeficiency Syndrome Patient

Abstract

Rapidly progressive renal failure in a patient living with human immunodeficiency virus is a curious scenario that encompasses differentials such as thrombotic microangiopathy, Immune reconstitution inflammatory syndrome, acute interstitial nephritis, and acute tubular necrosis. A 36-year-old male patient was admitted with fever and weakness for 2 months. He was detected to have pulmonary Koch’s and Human immunodeficiency virus positive. He was initiated on anti-tubercular regiemn followed by highly active anti-retroviral therapy. Patient also had decreased urine output since past 3 weeks. He had baseline creatinine of 1 which increased to 2.1 in 1st week, 3.2 in 2nd week and had progressive derangement in KFT for 5.1 in 3rd week. He was admitted in the 4th week when his serum creatinine was 6.9. As it further rose to 8.1 along with decreased urine output biopsy was planned in view of rapidly progressive renal failure and the patient was initiated on hemodialysis. Biopsy was suggestive of non-necrotizing granulomatous interstitial nephritis and glomeruli showed non – proliferative morphology. After highly active anti-retroviral therapy modification and steroid addition serum creatinine started coming down and patient became dialysis independent.