Acute poststreptococcal glomerulonephritis

A manifestation of immune reconstitution inflammatory syndrome

Julie Seale Martin, Aditya Kaul, Robert Schacht

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is a well-described complication of initiation of highly active antiretroviral therapy in HIV-infected patients. As the immune system recovers, an inappropriate inflammatory response often occurs that causes significant disease. It is most commonly seen in patients naïve to therapy with CD4+ T-lymphocyte counts <100 cells/cmm and usually presents as a flare of mycobacterial, cytomegalovirus, or herpes zoster infections. Less commonly, this syndrome occurs in response to noninfectious triggers and results in autoimmune or malignant disease. Here we present the first case of acute poststreptococcal glomerulonephritis associated with varicella zoster virus and IRIS in an adolescent with perinatally acquired HIV and hepatitis C virus infections. Our patient was not naïve to therapy but was starting a new regimen of therapy because of virologic failure and had a relatively high CD4+ T-lymphocyte count. This case report indicates that IRIS remains a concern after initiation of a new highly active antiretroviral therapy regimen in HIV-infected patients with high viral loads, even in the presence of CD4+ T-lymphocyte counts >100 cells/cmm. It may present as infectious, malignant, or autoimmune conditions including poststreptococcal glomerulonephritis.

Original languageEnglish (US)
JournalPediatrics
Volume130
Issue number3
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Immune Reconstitution Inflammatory Syndrome
Glomerulonephritis
Highly Active Antiretroviral Therapy
CD4 Lymphocyte Count
Immune System
HIV
T-Lymphocytes
Therapeutics

Keywords

  • Glomerulonephritis
  • HIV
  • Immune reconstitution inflammatory syndrome
  • Streptococcus
  • Varicella

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Acute poststreptococcal glomerulonephritis : A manifestation of immune reconstitution inflammatory syndrome. / Martin, Julie Seale; Kaul, Aditya; Schacht, Robert.

In: Pediatrics, Vol. 130, No. 3, 01.01.2012.

Research output: Contribution to journalArticle

@article{ff2f3e3f78384259a9922db4bc12c340,
title = "Acute poststreptococcal glomerulonephritis: A manifestation of immune reconstitution inflammatory syndrome",
abstract = "Immune reconstitution inflammatory syndrome (IRIS) is a well-described complication of initiation of highly active antiretroviral therapy in HIV-infected patients. As the immune system recovers, an inappropriate inflammatory response often occurs that causes significant disease. It is most commonly seen in patients na{\"i}ve to therapy with CD4+ T-lymphocyte counts <100 cells/cmm and usually presents as a flare of mycobacterial, cytomegalovirus, or herpes zoster infections. Less commonly, this syndrome occurs in response to noninfectious triggers and results in autoimmune or malignant disease. Here we present the first case of acute poststreptococcal glomerulonephritis associated with varicella zoster virus and IRIS in an adolescent with perinatally acquired HIV and hepatitis C virus infections. Our patient was not na{\"i}ve to therapy but was starting a new regimen of therapy because of virologic failure and had a relatively high CD4+ T-lymphocyte count. This case report indicates that IRIS remains a concern after initiation of a new highly active antiretroviral therapy regimen in HIV-infected patients with high viral loads, even in the presence of CD4+ T-lymphocyte counts >100 cells/cmm. It may present as infectious, malignant, or autoimmune conditions including poststreptococcal glomerulonephritis.",
keywords = "Glomerulonephritis, HIV, Immune reconstitution inflammatory syndrome, Streptococcus, Varicella",
author = "Martin, {Julie Seale} and Aditya Kaul and Robert Schacht",
year = "2012",
month = "1",
day = "1",
doi = "10.1542/peds.2011-1246",
language = "English (US)",
volume = "130",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "3",

}

TY - JOUR

T1 - Acute poststreptococcal glomerulonephritis

T2 - A manifestation of immune reconstitution inflammatory syndrome

AU - Martin, Julie Seale

AU - Kaul, Aditya

AU - Schacht, Robert

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Immune reconstitution inflammatory syndrome (IRIS) is a well-described complication of initiation of highly active antiretroviral therapy in HIV-infected patients. As the immune system recovers, an inappropriate inflammatory response often occurs that causes significant disease. It is most commonly seen in patients naïve to therapy with CD4+ T-lymphocyte counts <100 cells/cmm and usually presents as a flare of mycobacterial, cytomegalovirus, or herpes zoster infections. Less commonly, this syndrome occurs in response to noninfectious triggers and results in autoimmune or malignant disease. Here we present the first case of acute poststreptococcal glomerulonephritis associated with varicella zoster virus and IRIS in an adolescent with perinatally acquired HIV and hepatitis C virus infections. Our patient was not naïve to therapy but was starting a new regimen of therapy because of virologic failure and had a relatively high CD4+ T-lymphocyte count. This case report indicates that IRIS remains a concern after initiation of a new highly active antiretroviral therapy regimen in HIV-infected patients with high viral loads, even in the presence of CD4+ T-lymphocyte counts >100 cells/cmm. It may present as infectious, malignant, or autoimmune conditions including poststreptococcal glomerulonephritis.

AB - Immune reconstitution inflammatory syndrome (IRIS) is a well-described complication of initiation of highly active antiretroviral therapy in HIV-infected patients. As the immune system recovers, an inappropriate inflammatory response often occurs that causes significant disease. It is most commonly seen in patients naïve to therapy with CD4+ T-lymphocyte counts <100 cells/cmm and usually presents as a flare of mycobacterial, cytomegalovirus, or herpes zoster infections. Less commonly, this syndrome occurs in response to noninfectious triggers and results in autoimmune or malignant disease. Here we present the first case of acute poststreptococcal glomerulonephritis associated with varicella zoster virus and IRIS in an adolescent with perinatally acquired HIV and hepatitis C virus infections. Our patient was not naïve to therapy but was starting a new regimen of therapy because of virologic failure and had a relatively high CD4+ T-lymphocyte count. This case report indicates that IRIS remains a concern after initiation of a new highly active antiretroviral therapy regimen in HIV-infected patients with high viral loads, even in the presence of CD4+ T-lymphocyte counts >100 cells/cmm. It may present as infectious, malignant, or autoimmune conditions including poststreptococcal glomerulonephritis.

KW - Glomerulonephritis

KW - HIV

KW - Immune reconstitution inflammatory syndrome

KW - Streptococcus

KW - Varicella

UR - http://www.scopus.com/inward/record.url?scp=84865777507&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865777507&partnerID=8YFLogxK

U2 - 10.1542/peds.2011-1246

DO - 10.1542/peds.2011-1246

M3 - Article

VL - 130

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 3

ER -