Crescentic IgA nephropathy and acute renal failure in an HIV-positive patient with enteric salmonella infection.

The association of HIV with renal disease has been well documented since the early days of the epidemic [1]. Heavy proteinuria and rapid progression to renal failure are described as clinical characteristics in most cases arising in HIV-infected patients. On renal biopsy many of these patients have been shown to have a distinctive combination of focal segmental glomerulosclerosis (FSGS), cystic tubular damage, and extensive collections of tubular reticular inclusions (TRI) in a variety of cell types [1,2]. This constellation of findings has been termed 'HIV-associated nephropathy' by some authors. However, there is a wide spectrum of clinical manifestations of renal disease in patients with HIV infection [2]. In addition to the characteristic histopathological findings of mesangial expansion and/or FSGS, immune complex glomerulonephropathies have also been described in patients with HIV. A significant proportion of these cases consist of HIV-positive patients with IgA nephropathy [3-6]. There are rare reports of crescentic IgA nephropathy associated with HIV infection [3,7,8]. Most cases of crescentic IgA nephropathy are idiopathic and no precipitating cause for nephropathy is ever identified. We report here the case of a young black male with a 10-year history of HIV infection who presented with an acute febrile illness secondary to Salmonella typhimurium enteritis who developed a crescentic IgA glomerulonephritis with acute renal failure. The patient's renal failure resolved completely with treatment of the infection and a short course of steroids.