A South African man with renal failure and pulmonary shadowing

• Published in: BMJ (Online) 2012-06, Vol.344 (jun11 1), p.e2789-e2789
• Main Authors: Chanchlani, Neil, Neale, Elizabeth, Rylance, Paul B
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acute Kidney Injury - diagnosis; Acute Kidney Injury - therapy; Adult; AIDS; AIDS-Associated Nephropathy - diagnosis; AIDS-Associated Nephropathy - therapy; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; Anti-Infective Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Antigens; Antiretroviral drugs; Bacterial infections; Cavitation; Diagnosis, Differential; Drug therapy; Edema; Hemodialysis; HIV; HIV Seropositivity - diagnosis; HIV Seropositivity - drug therapy; Human immunodeficiency virus; Humans; Immunology; Kidney diseases; Kidneys; Male; Medication Adherence; Patients; Pneumocystis carinii; Pneumonia; Pneumonia, Pneumocystis - diagnosis; Pneumonia, Pneumocystis - diagnostic imaging; Pneumonia, Pneumocystis - drug therapy; Polymerase chain reaction; Radiography; Renal Dialysis; Renal failure; Streptococcus infections; Transplants & implants; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Tuberculosis; Ultrasonic imaging; Urinalysis; Urine; Viral infections
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.e2789

According to local hospital guidelines, combination treatment with piperacillin and tazobactam (Tazocin), clarithromycin, and co-trimoxazole was given to cover bacterial, atypical, and opportunistic organisms. Viral organisms can also be tested using reverse transcription polymerase chain reaction on swabs taken from the nose and throat. Because of the patient's ethnicity and country of origin, serological testing for HIV is needed. Highly active antiretroviral therapy for the treatment of HIV can contribute to renal dysfunction-indinavir is associated with renal stone formation, 8 and tenovir can cause proximal tubule damage. 3 9 Antibiotics and antifungals used to treat opportunistic infections in patients with HIV, such as gentamicin and amphotericin, can cause acute tubular necrosis or allergic interstitial nephritis. 10 HIV associated nephropathy is the most common cause of end stage renal failure in HIV seropositive patients, and nearly 90% of cases are in black people of African descent. 8 11 Patients present with high serum concentrations of creatinine and proteinuria that is often in the nephrotic range (>3 g/24 h). [...]haemodialysis is indicated in an HIV positive patient while awaiting consideration of suitability for renal transplantation.