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Diagnosis: Diffuse Proliferative Endocapillary Glomerulonephritis, Immune Complex-Mediated (~Postinfectious)
In this case, the immunostaining pattern: lumpy dumpy, for IgG and C3 is strongly suggestive of post-infectious GN (acute), however, for the diagnosis it is essential to demonstrate the previous infection, which was not possible in our patient.
In the context of a patient with HIV infection, some patients include this case in the category of HIV-associated immune complex kidney disease (HIVICK) (Foy MC, et al. Comparison of risk factors and outcomes in HIV immune complex kidney disease and HIV-associated nephropathy. Clin J Am Soc Nephrol. 2013;8(9):1524-32. [PubMed link]).
However, many authors restrict the diagnosis of HIVICK to the lupus-like lesions that are seen in some HIV-infected patients, without serologic evidence of lupus, with immunofluorescence showing a “Full-house” staining (positivity for IgG, IgA, IgM, C3, and C1q, granular in the mesangium and capillary loops). (Fogo AB, et al. AJKD Atlas of Renal Pathology: HIV-Associated Immune Complex Kidney Disease (HIVICK). Am J Kidney Dis. 2016;68(2):e9-e10. [PubMed link]).
See the chapter: Endocapillary Proliferativa GN of our Tutorial (only Spanish version).
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References
- Murakami CA, Attia D, Carter-Monroe N, Lucas GM, Estrella MM, Fine DM, Atta MG. The clinical characteristics and pathological patterns of postinfectious glomerulonephritis in HIV-infected patients. PLoS One. 2014 Oct 1;9(10):e108398. [PubMed link]
- Kupin WL. Viral-Associated GN: Hepatitis C and HIV. Clin J Am Soc Nephrol. 2017;12(8):1337-1342. [PubMed link]
- Nobakht E, Cohen SD, Rosenberg AZ, Kimmel PL. HIV-associated immune complex kidney disease. Nat Rev Nephrol. 2016;12(5):291-300. [PubMed link]
- Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKD Atlas of Renal Pathology: HIV-Associated Immune Complex Kidney Disease (HIVICK). Am J Kidney Dis. 2016;68(2):e9-e10. [PubMed link]
- Foy MC, Estrella MM, Lucas GM, Tahir F, Fine DM, Moore RD, Atta MG. Comparison of risk factors and outcomes in HIV immune complex kidney disease and HIV-associated nephropathy. Clin J Am Soc Nephrol. 2013;8(9):1524-32. [PubMed link]