LUPUS-LIKE NEPHRITIS IN A CHILD WITH AIDS:

Abstract • 69 HIV associated nephropathy is rare in children. We report a patient with HIV lupus-like nephropathy in vertical transmission. A 12-yr-old boy was admitted for the first time with fever and generalized edematosis. He had high blood pressure, macroscopic hematuria, proteinuria (6 g/l), and renal failure (serum creatinine: 250 µmol/l), hepato-splenomegaly, lymphadenopathy. There was aregenerative anemia (Hb 4.7 g/l) lymphopenia with low CD4 counts (200/mm/3) and hypergammaglobulinemia (IgG 24g/l). HIV RNA = 495 000 copies/mL. Kidneys were bulky and hyperechogenic. A renal biopsy showed proliferative glomerulonephritis with diffuse endocapillary proliferative changes, wire-loops, hyaline thrombi and endo- and extramembranous deposits of IgGG, IgA, C3, C1q resembling lupus nephritis; but extrarenal symptoms and nuclear antibodies suggestive of SCE were absent. Treatment with corticosteroids, antiviral tritherapy, and cotrimoxazole improved both his renal functions and immune status. Different types of renal lesions are seen in AIDS patients the most common being HIV associated nephropathy with focal and segmental glomerulosclerosis. Lupus-like nephropathy, possibly due to polyclonal B-cell activation, has rarely been described in childhood and seems to have a better prognosis.