Minimal change nephrotic syndrome in patients infected with human immunodeficiency virus: a retrospective study of 8 cases

Romain Arrestier (1, 2) , Anne-Pascale Satie (3) , S. Y. Zhang (2) , E. Plaisier (4, 5, 6) , C. Isnard-Bagnis (7) , Philippe Gatault (8) , Quentin Raimbourg (9) , David Buob (4) , Flavia Vocila (10) , Anne-Elisabeth Heng (11, 12) , Hélène Francois (13) , Anissa Moktefi (14, 2) , Guillaume Canaud , Marie Matignon (1, 2) , Nathalie Dejucq-Rainsford (3) , Isabelle Brocheriou (7) , Dil Sahali (1, 2) , Vincent Audard (1, 2)

1 Néphrologie Transplantation
2 IMRB - Institut Mondor de Recherche Biomédicale
3 Irset - Institut de recherche en santé, environnement et travail
4 CHU Tenon [AP-HP]
5 SU - Sorbonne Université
6 Centre de Référence Maladies Rares « Syndrome Néphrotique Idiopathique de l’Enfant et de l’Adulte »
7 CHU Pitié-Salpêtrière [AP-HP]
8 service de Néphrologie
9 service de Néphrologie
10 Service Néphrologie
11 UNH - Unité de Nutrition Humaine
12 Service Néphrologie Dialyse Transplantation
13 service de Médecine Interne et d'Immunologie Clinique
14 service Anatomie et Cytologie Pathologique

BACKGROUND: Human immunodeficiency virus (HIV) is associated with diverse glomerular diseases. Characteristics of minimal change nephrotic syndrome (MCNS) in this setting have been little studied, and the specific features of this uncommon association remain to be determined. METHODS: We conduct a retrospective study. Clinical, biological and pathological characteristics of patients with MCNS and HIV infection were assessed. We evaluated HIV infection by in situ hybridization and CMIP expression by immunochemistry on kidney biopsies and compared it to HIV-associated nephropathy (HIVAN) and idiopathic MCNS. RESULTS: Eight patients were identifies. In all but one of these cases, MCNS occurred after HIV diagnosis (mean of 9.5 years). Acute kidney injury was detected in three cases. Mean CD4(+) lymphocyte count was 733/mm(3) and three patients had a detectable HIV viral load. In situ hybridization for HIV-1 RNA detection yielded a positive signal in a few tubular cells in the renal parenchyma in two of four patients with HIV infection associated with MCNS. Podocytes of these patients presented strong positive immunostaining for CMIP (4/4). Three patients suffered steroid-dependent nephrotic syndrome, and another two patients had at least one relapse. Rituximab treatment was initiated in four cases. After a median follow-up of 20 months, all patients were in remission (complete in 5 cases). CONCLUSIONS: In patients with MCNS occurring in a context of HIV infection, podocyte injury seems to be associated with CMIP induction rather than renal HIV infection but further studies are needed to determine the molecular link between these two conditions.

Mots clés: Rituximab; C-mip; Albuminuria; Aids; Podocytes; HIV infection; Minimal change nephrotic syndrome

Domaines: Médecine humaine et pathologie; Urologie et Néphrologie

Romain Arrestier, Anne-Pascale Satie, S. Y. Zhang, E. Plaisier, C. Isnard-Bagnis, et al.. Minimal change nephrotic syndrome in patients infected with human immunodeficiency virus: a retrospective study of 8 cases. BMC Nephrology, 2018, 19 (1), 9 p. ⟨10.1186/s12882-018-1132-x⟩. ⟨hal-01947499⟩