LATE RENAL-ALLOGRAFT FAILURE SECONDARY TO THROMBOTIC MICROANGIOPATHY HUMAN-IMMUNODEFICIENCY-VIRUS NEPHROPATHY

The case of a renal transplant recipient with a known history of iv dr ug abuse but unknown human immunodeficiency virus (HIV) status who pre sents after having a stable renal allograft function for 4 yr, with ac ute/subacute advanced renal failure, nephrotic syndrome, and hypertens ion, as well as clinical and histologic findings of thrombotic microan giopathy, is reported. He was subsequently found to have a positive se rology for HIV-1 with a low CD4 count but no clinical manifestations o f the acquired immunodeficiency syndrome. He was treated conservativel y with zidovudine (AZT). The patient never regained graft function and was ultimately discharged from the hospital on maintenance dialytic t herapy. This is, to our knowledge, the first report of thrombotic micr oangiopathy in an HIV-1-infected patient presenting late in the course as acute/subacute renal allograft failure.