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).