A Case of aHUS-Associated Renal Failure Mistakenly Attributed to HIV Nephropathy

Human immunodeficiency virus infection has been implicated in multiple viral-based processes adversely affecting the renal system, including HIV-associated nephropathy (HIVAN), HIV-related immune complex disease, and the less well-described HIV-related thrombotic microangiopathy (TMA). While HIV nephropathy has an overall poor renal prognosis and is treated primarily with anti-viral therapy, the etiology of HIV-related (non-thrombotic thrombocytopenic purpura-associated) renal TMA may be causally linked to viral amplification of a dysregulated alternate complement cascade. Thus, if detected in its incipient stages, the associated renal injury may respond similarly to complement-inhibitory modalities as has been observed in cases of non-virally-linked TMA (aHUS), thus yielding significant recovery of kidney function. We report a case of a 43-year-old male patient with a history of advanced HIV disease and chronic renal insufficiency, previously attributed to HIVAN, who presented with acute renal decline, microangiopathic hemolytic anemia and thrombocytopenia, and biopsy-proven renal TMA, whose acute renal decompensation responded favorably to terminal complement blockade (eculizumab). J Hematol. 2015;4(1):141-143 doi: http://dx.doi.org/10.14740/jh183w