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Renal manifestations in children co-infected with HIV and disseminated tuberculosis

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Abstract

Many children in Cape Town are co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB). Granulomatous TB interstitial nephritis is a recognized entity. Our objective was to establish if TB plays a role in renal disease in HIV-infected children. We identified children co-infected with TB and HIV from our database and reviewed their biopsies and clinical notes. Since 2002, 12 renal biopsies or postmortem examinations were performed on HIV-infected children at our institution. The clinical scenario and renal biopsies in four cases (median age 73 months, range 24–108 months) were consistent with TB involvement. The mean CD4 count and percentage of these four patients were 508 cells/µl and 23%, respectively. All four patients presented with culture-proven disseminated TB (not yet on treatment) and had nephrotic range proteinuria and hypoalbuminemia. Three of these patients had renal impairment. The prominent features of the renal biopsies were a severe interstitial inflammatory infiltrate and mild to moderate mesangial proliferation. An interstitial granuloma was seen in one patient. With treatment for the TB, the proteinuria resolved and renal function improved in all four patients. Based on these results, we conclude that TB contributes to proteinuric renal disease in HIV-infected children and that the renal disease improves following TB treatment.

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Fig. 1

Abbreviations

HIV:

Human immunodeficiency virus

HIVAN:

Human immunodeficiency virus-associated nephropathy

eGFR:

Estimated glomerular filtration rate

HAART:

Highly active antiretroviral therapy

TB:

Tuberculosis

TNF:

Tumor necrosis factor

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Authors and Affiliations

  1. School of Child and Adolescent Health, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa

    Peter J. Nourse

  2. Department of Pediatrics and Child Health, Tygerberg Children’s Hospital–Stellenbosch University, Stellenbosch, South Africa

    Mark F. Cotton

  3. National Health Laboratory Service, Tygerberg Hospital–Stellenbosch University, Stellenbosch, South Africa

    William D. Bates

Authors
  1. Peter J. Nourse
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  2. Mark F. Cotton
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  3. William D. Bates
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Corresponding author

Correspondence to Peter J. Nourse.

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Name of institution to which work should be attributed to: Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Stellenbosch University.

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Nourse, P.J., Cotton, M.F. & Bates, W.D. Renal manifestations in children co-infected with HIV and disseminated tuberculosis. Pediatr Nephrol 25, 1759–1763 (2010). https://doi.org/10.1007/s00467-010-1520-3

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  • DOI: https://doi.org/10.1007/s00467-010-1520-3

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