Abstract
Background A 30-year-old HIV-infected woman presented with fever and abdominal pain 4 days after initiation of highly active antiretroviral therapy (HAART), and 1 month after initiation of antimicrobial therapy for Mycobacterium tuberculosis infection. A diagnosis of immune restoration inflammatory syndrome (IRIS) was considered, and corticosteroids were started. Steroid therapy doses were progressively tapered, during which time the patient developed renal failure with enlarged kidneys. A renal biopsy showed acute interstitial nephritis. Extensive investigations failed to detect active infection. The efficacy of HAART was attested by increased CD4+ cell counts and undetectable viral replication.
Investigations Physical examination, plasma viral load and CD4+ cell count, abdominal and renal ultrasound, renal and peritoneal biopsies, renal and liver function, chest X-ray, and bronchoalveolar lavage culture.
Diagnosis Acute renal failure secondary to IRIS.
Management Prednisone therapy.
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Acknowledgements
E Daugas and E Plaisier contributed equally to this work.
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Daugas, E., Plaisier, E., Boffa, JJ. et al. Acute renal failure associated with immune restoration inflammatory syndrome. Nat Rev Nephrol 2, 594–598 (2006). https://doi.org/10.1038/ncpneph0282
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DOI: https://doi.org/10.1038/ncpneph0282
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