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Interpretation of serologic tests in an HIV-infected patient with kidney disease

Nature Clinical Practice Nephrology volume 2, pages 708–712 (2006)Cite this article

Abstract

Background A 32-year-old African American man with HIV infection presented with hemoptysis, shortness of breath and renal insufficiency. Serologic testing revealed the presence of anti-glomerular basement membrane antibodies and equivocal levels of anti-myeloperoxidase antibodies.

Investigations Physical examination, urine and blood analysis, kidney ultrasound, chest radiograph, sputum cultures, bronchoscopy and renal biopsy.

Diagnosis Reactivation of tuberculosis infection, immune complex glomerulonephritis, and 'false-positive' anti-glomerular basement membrane and anti-myeloperoxidase antibodies.

Management Directly observed therapy with four-drug anti-tuberculosis therapy and conservative management of chronic kidney disease.

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Figure 1: Renal biopsy.
Figure 2: Possible mechanisms of autoantibody production in HIV-infected individuals without autoimmune disease.

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Acknowledgements

We thank Dr Doug Hanks for providing the pathology slide.

Author information

Authors and Affiliations

  1. Medicine at the Department of Internal Medicine Texas Tech University Health Sciences Center at El Paso, El Paso, TX

    German T Hernandez

  2. Department of Medicine San Francisco General Hospital University of California, San Francisco

    German T Hernandez

  3. Assistant Clinical Professor of Medicine,

    Jeffrey M Critchfield & Rudolph A Rodriguez

  4. Clinical Medicine and Director of Clinical Nephrology at the Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA

    Jeffrey M Critchfield & Rudolph A Rodriguez

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  1. German T Hernandez
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  2. Jeffrey M Critchfield
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Correspondence to German T Hernandez.

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The authors declare no competing financial interests.

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Hernandez, G., Critchfield, J. & Rodriguez, R. Interpretation of serologic tests in an HIV-infected patient with kidney disease. Nat Rev Nephrol 2, 708–712 (2006). https://doi.org/10.1038/ncpneph0324

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