CLINICOPATHOLOGICAL CORRELATES OF PREDNISONE TREATMENT OF HUMAN IMMUNODEFICIENCY VIRUS-ASSOCIATED NEPHROPATHY

A 43-YEAR-OLD MAN with rapidly evolving renal failure from biopsy-prov en human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) a nd superimposed thrombotic microangiopathic changes was treated with p rednisone, His serum creatinine decreased from 7.5 to 3.9 mg/dL, and t he 24-hour protein excretion decreased from 15.7 to 6.1 g over 6 to 8 weeks, As the prednisone was tapered, however, the creatinine began to increase, and a repeat biopsy was done to assist with therapeutic dec isions, The major differences from the pretreatment biopsy were marked reductions in interstitial lymphocytes and macrophages and absence of thrombotic microangiopathic lesions, This is the first report compari ng pretreatment and posttreatment renal biopsy specimens and the findi ngs provide some insight into the means by which prednisone exerts its beneficial clinical effects acutely on this disease. (C) 1996 by the National Kidney Foundation, Inc.