A Case of Secondary Renal Amyloidosis Associated with HIV

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Introduction: Secondary amyloidosis is known to be associated with multiple chronic infections and inflammatory conditions including rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and tuberculosis. HIV has not yet been established as a known association. We present a case of secondary amyloidosis associated with well-controlled HIV with no history of other potential etiologies. Case Description: A 71-year-old man with hypertension and well-controlled HIV for 40 years (viral load undetectable and last CD4 917) was referred to the renal clinic for acute kidney injury and heavy proteinuria. He had complained of leg swelling and foamy urine. Spot urine protein:creatinine ratio was 10 and albumin was 1.6 mg/dL. The creatinine had slowly risen over several months from 0.9 mg/dL to a plateau of 1.8. Serologic work-up was unrevealing; PLA2r, complements, hepatitis serologies, ANA, ANCA, A1C, SPEP, immunofixation, and free light chains were all normal. Renal biopsy demonstrated amorphous deposits throughout the glomeruli which stained positive for serum amyloid A (SAA) (figure 1). We found no systemic causes to explain secondary amyloidosis. This case demonstrates a possible association of secondary amyloidosis with HIV. Discussion: Only a few case reports have described an association of secondary amyloidosis with HIV. SAA renal amyloidosis has been described in a patient who acquired HIV via intravenous drug use. It was unclear if it was related to the HIV disease or to chronic inflammation from skin infections due to needle use. Renal amyloidosis has also been occasionally described in South African patients with HIV and in non-human primates with HIV-like disease. Elevated levels of amyloid A protein have been found in AIDS patients, suggesting a possible pathogenetic linkage. More studies are needed in this area to determine if there is a causal relationship between the two disorders and what is the best approach for management.Positive SAA staining

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