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A case of acute renal failure associated with diffuse infiltrative lymphocytosis syndrome

Nature Clinical Practice Nephrology volume 4, pages 110–114 (2008)Cite this article

Abstract

Background A 58-year-old African American man with an uncontrolled HIV infection presented to hospital with nephrotic syndrome and diffuse lymphadenopathy. The patient had been taking highly active antiretroviral therapy (HAART; lamivudine, abacavir, fosamprenavir and ritonavir) for 10 years. A renal biopsy showed acute granulomatous interstitial nephritis. Despite a negative tuberculin skin test, he was treated with antituberculosis drugs for 12 months without improvement of his renal profile. Two months after antituberculosis treatment was discontinued, the patient was readmitted to hospital because of acute renal failure. Corticosteroid therapy (prednisone) was started and resulted in a marked improvement in renal function. However, 18 months after steroids were discontinued, renal function declined dramatically. Furthermore, the patient had CD8+ lymphocytosis as well as interstitial tissue infiltration by CD8+ T lymphocytes.

Investigations Physical examination, plasma HIV viral load, lymphocyte counts, urinalysis, tuberculin skin test, liver function tests, renal ultrasonography, human leukocyte antigen (HLA) typing, renal and minor salivary gland biopsies, ophthalmological examination, chest radiography and culture of bronchoalveolar lavage fluid.

Diagnosis Acute granulomatous interstitial nephritis secondary to diffuse infiltrative lymphocytosis syndrome.

Management HAART and prednisone.

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Figure 1: Renal biopsy specimen at initial presentation showing expansion of the renal interstitium by large inflammatory cell aggregates containing lymphocytes and fibrosis.
Figure 2: Immunophenotyping analysis of second follow-up renal biopsy specimen.

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Authors and Affiliations

  1. L Camous and E Bourry are Junior Registrars in the Department of Nephrology, G Deray is Head of the Department of Nephrology, H Izzedine is a Consultant Nephrologist, I Brocheriou is a Consultant Histopathologist, M-A Valantin is a Consultant in Infectious Diseases, A Baumelou is a Professor of Nephrology, and C Katlama is a Professor of Infectious Diseases, all at Pitié-Salpêtrière Hospital, Paris, France.,

    Hassane Izzedine, Isabelle Brocheriou, Marc-Antoine Valantin, Laurent Camous, Edward Bourry, Alain Baumelou, Gilbert Deray & Christine Katlama

Authors
  1. Hassane Izzedine
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  2. Isabelle Brocheriou
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  3. Marc-Antoine Valantin
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  4. Laurent Camous
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  8. Christine Katlama
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Correspondence to Hassane Izzedine.

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The authors declare no competing financial interests.

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Izzedine, H., Brocheriou, I., Valantin, MA. et al. A case of acute renal failure associated with diffuse infiltrative lymphocytosis syndrome. Nat Rev Nephrol 4, 110–114 (2008). https://doi.org/10.1038/ncpneph0674

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