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M9490318.TXT
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1994-09-19
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Document 0318
DOCN M9490318
TI Effect of corticosteroid therapy on human immunodeficiency
virus-associated nephropathy.
DT 9411
AU Smith MC; Pawar R; Carey JT; Graham RC Jr; Jacobs GH; Menon A; Salata
RA; Seliga R; Kalayjian RC; Department of Medicine, Case Western Reserve
University School of; Medicine, Cleveland, Ohio.
SO Am J Med. 1994 Aug;97(2):145-51. Unique Identifier : AIDSLINE
MED/94337781
AB PURPOSE: Human immunodeficiency virus-associated nephropathy (HIV-AN)
occurs predominantly in blacks and is characterized histologically by
focal segmental glomerulosclerosis or mesangial proliferation and a
lymphohistiocytic tubulointerstitial infiltrate. Patients manifest heavy
proteinuria and, once azotemia occurs, progress rapidly to end-stage
renal disease within 2 to 6 months. No treatment has been shown to be
useful for HIV-AN. The purpose of this study was to determine the effect
of corticosteroid agents on the progression of HIV-AN. PATIENTS AND
METHODS: Four consecutive HIV-infected adults with fewer than 200 CD4
cells/microL, moderate to severe renal insufficiency, proteinuria
greater than 2 g per 24 hours, and HIV-AN demonstrated by renal biopsy
were treated with 60 mg of prednisone daily for 2 to 6 weeks. Patients
were followed with respect to serum creatinine level, 24-hour protein
excretion, adverse drug reactions, and the occurrence of opportunistic
infections. RESULTS: CD4 counts ranged from 30 to 80 cells/microL before
therapy with steroids. The mean (+/- SD) pretreatment serum creatine
concentration was 9.1 +/- 5.7 mg/dL and decreased to 3.3 +/- 1.8 mg/dL
(P < 0.05) after 2 to 6 weeks of corticosteroid therapy. Twenty-four
hour protein excretion did not change (5.2 +/- 2.4 g pretreatment versus
4.6 +/- 4.1 g posttreatment). One patient was able to discontinue
dialysis after 10 days. Two patients developed Mycobacterium
avium-complex infections and steroid-associated psychosis. One of these
patients developed a recurrence of genital herpes, and the other
developed dermatomal zoster. None of the four required dialysis during a
1.5- to 5.5-month period of follow-up after cessation of steroid
treatment. CONCLUSION: In selected patients with HIV-AN, short-term
treatment with corticosteroid agents improves renal function and
prevents the development of end-stage renal disease during a 1.5- to
5.5-month period of observation, but may be associated with an increased
risk of opportunistic infection.
DE Adult Case Report Drug Administration Schedule Female Human HIV
Infections/*COMPLICATIONS Kidney/PATHOLOGY Kidney Diseases/*DRUG
THERAPY/MICROBIOLOGY/PATHOLOGY Male Middle Age Prednisone/ADVERSE
EFFECTS/*THERAPEUTIC USE JOURNAL ARTICLE REVIEW REVIEW OF REPORTED
CASES
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).