HIV-associated immune complex glomerulonephritis with lupus-like features

Renal structural abnormalities in HIV/AIDS infected patients have been infrequently and incompletely reported in patients from sub-Saharan Africa. We report an immune complex glomerulonephritis with lupus-like features in a ten-year-old HIV+ boy who was evaluated at the University Hospital of Kinshasa. The light microscopic examination of the renal biopsy displayed a predominantly membranoproliferative glomerulonephritis with prominent focal segmental necrotizing injury,numerous wire-loops,and a spiky membranous nephropathy. In addition,there were prominent tubular injury,microcysts filled with periodic acid-Schiff (PAS) positive casts,edema and an inflammatory infiltrate of the interstitium,features of a classic HIV-associated nephropathy (HIVAN). Electron microscopy revealed large subendothelial,intra-membranous,subepithelial and mesangial deposits. The combination of these findings,while being consistent with lupus nephritis WHO grade IV/V,the tubulointerstitial HIVAN-like changes and the absence of clinical evidence of lupus disease favored an HIV-associated immune complex glomerulonephritis with lupus-like features.