Authors
Pranjal Kashiv, Milind Bhrushundi, Amit Pasari, Shubham Dubey, Vijay Jeyachandran, Twinkle Pawar, Kapil Sejpal, Mohit Kurundwadkar, Manish Balwani, Vivek B Kute
Published in
BMJ case reports. Volume 19. Issue 8. Aug 17, 2026. Epub Aug 17, 2026.
Abstract
Renal disease in people living with HIV extends beyond classical HIV-associated nephropathy to include immune-mediated and vasculitic lesions, of which pauci-immune crescentic glomerulonephritis is among the rarest and most easily missed. We describe two biopsy-proven cases with anti-myeloperoxidase anti-neutrophil cytoplasmic antibody positivity. The first, established on antiretroviral therapy, presented with a pulmonary-renal syndrome after empirical anti-tubercular treatment had failed; biopsy showed cellular crescents without chronic change, and corticosteroids with rituximab achieved sustained clinical, biochemical and serological remission. The second, antiretroviral-naive, had glomerular haematuria and proteinuria documented at HIV diagnosis and an ischaemic stroke soon afterwards, but declined nephrological assessment; biopsy 3 years later was dominated by global glomerulosclerosis and interstitial fibrosis and he remained dialysis-dependent. The divergence turned on the histological stage at diagnosis rather than antiretroviral status and argues for early biopsy whenever unexplained renal decline with an active urinary sediment occurs in HIV.
PMID:
42608064
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.
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