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March 1993

A Steroid-Responsive Nephropathy in a Child With Human Immunodeficiency Virus Infection

Author Affiliations

Department of Medicine; Department of Pediatrics; Departments of Pediatrics, Microbiology, and Immunology Albert Einstein College of Medicine 1300 Morris Park Ave Bronx, NY 10461-1602

Am J Dis Child. 1993;147(3):261-262. doi:10.1001/archpedi.1993.02160270023008

Sir.—The spectrum of renal diseases in patients infected with human immunodeficiency virus (HIV) includes glomerular lesions such as HIV-associated nephropathy and acute renal failure due to ischemia or nephrotoxins, and nonglomerular processes, such as interstitial nephritis, nephrocalcinosis, renal cell carcinoma, Kaposi's sarcoma, lymphoma, and intrarenal infection.1 We describe here a child infected with HIV in whom the nephropathy was characterized histologically and who, contrary to previous experiences, responded well to steroid therapy.

Patient Report.—The patient initially presented at 3 years of age with progressive lymphocytic interstitial pneumonitis. Because of an underlying severe B-cell defect and recurrent infections, she was treated with periodic intravenous dosages of gamma globulin (300 mg/kg biweekly) since 4 years of age. At 10 years of age she developed symptomatic accelerated hypertension, a decrease in creatinine clearance to 20 mL/min, and a proteinuria of 0.6 g/d. A renal biopsy revealed mild glomerular hypercellularity with

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