CLINICOPATHOLOGICAL CONFERENCE
Human Immunodeficiency Virus Infection and Nephrotic Syndrome Stephen M. Korbet, MD (Clinical Discussant), and Melvin M. Schwartz, MD (Pathologist) CASE A 31-YEAR-OLD HOMOSEXUAL black man with a past history of intravenous drug abuse was found to be positive for human immunodeficiency virus (HIV) by enzyme immunoassay and Western blot tests in August 1989. In February 1990, he was started on zidovudine. In September 1990, he presented to the hospital with a 3-day history of abdominal pain and cramping. He was febrile to 102°F. The admission urinalysis had 4+ protein by dipstix and microscopic hematuria, and the serum creatinine was 88 ILmoljL (1.0 mg/dL). There was no previous history of renal disease, hypertension, or edema. A workup for gastrointestinal disorders was negative, as were evaluations for infections. However, a gallium scan demonstrated marked uptake in the bones, kidneys, and liver. On physical examination, the patient appeared well developed and well nourished. His blood pressure was 132/96 mm Hg, there were small hard posterior cervical glands, and he had 2+ pretibial edema bilaterally. The remainder of the examination was unremarkable. By the third hospital day, he had spontaneously defervesced, and the abdominal pain had resolved. His serum creatinine was 80 ILmoljL (0.9 mg/dL), with a serum albumin of 21 gil (2.1 g/dL) and a total cholesterol of 4.6 mmoljL (177 mg/dL). Hemoglobin was 10.2 g/dL, and the white blood cell count 4,100 cellS/ILL, with a normal differential and platelet count. The T-cell helper/suppressor ratio (CD4/CD8) was 0.2 (normal, 0.8 to 2.9). The sickle cell solubility test was positive, and the patient had 30.6% hemoglobin-So Urinalysis had 4+ protein with microscopic hematuria, but no red blood cell (RBC) casts. A 24-hour urine had 12 g of protein. The Westergren sedimentation rate was 84 mm/h. Antinuclear antibody test was negative, and C4 titer was normal. Rheumatoid factor (latex) was 1:320, and C3 titer was low at 0.6 gil (59 mg/dL) (normal, 0.8 to 1.8 g/ L [80 to 180 mg/dL]). The cryoprecipitate was 0.7% (normal,
Human Immunodeficiency Virus Infection and Nephrotic Syndrome Stephen M. Korbet, MD (Clinical Discussant), and Melvin M. Schwartz, MD (Pathologist) CASE A 31-YEAR-OLD HOMOSEXUAL black man with a past history of intravenous drug abuse was found to be positive for human immunodeficiency virus (HIV) by enzyme immunoassay and Western blot tests in August 1989. In February 1990, he was started on zidovudine. In September 1990, he presented to the hospital with a 3-day history of abdominal pain and cramping. He was febrile to 102°F. The admission urinalysis had 4+ protein by dipstix and microscopic hematuria, and the serum creatinine was 88 ILmoljL (1.0 mg/dL). There was no previous history of renal disease, hypertension, or edema. A workup for gastrointestinal disorders was negative, as were evaluations for infections. However, a gallium scan demonstrated marked uptake in the bones, kidneys, and liver. On physical examination, the patient appeared well developed and well nourished. His blood pressure was 132/96 mm Hg, there were small hard posterior cervical glands, and he had 2+ pretibial edema bilaterally. The remainder of the examination was unremarkable. By the third hospital day, he had spontaneously defervesced, and the abdominal pain had resolved. His serum creatinine was 80 ILmoljL (0.9 mg/dL), with a serum albumin of 21 gil (2.1 g/dL) and a total cholesterol of 4.6 mmoljL (177 mg/dL). Hemoglobin was 10.2 g/dL, and the white blood cell count 4,100 cellS/ILL, with a normal differential and platelet count. The T-cell helper/suppressor ratio (CD4/CD8) was 0.2 (normal, 0.8 to 2.9). The sickle cell solubility test was positive, and the patient had 30.6% hemoglobin-So Urinalysis had 4+ protein with microscopic hematuria, but no red blood cell (RBC) casts. A 24-hour urine had 12 g of protein. The Westergren sedimentation rate was 84 mm/h. Antinuclear antibody test was negative, and C4 titer was normal. Rheumatoid factor (latex) was 1:320, and C3 titer was low at 0.6 gil (59 mg/dL) (normal, 0.8 to 1.8 g/ L [80 to 180 mg/dL]). The cryoprecipitate was 0.7% (normal,
