Clinical remission of IgA nephropathy in an HIV-positive patient after combined treatment with tonsillectomy and steroid pulse therapy.

Various renal diseases other than human immunodeficiency virus (HIV)-associated nephropathy, including IgA nephropathy (IgAN), have been recently reported to cause chronic kidney disease and end-stage renal disease in HIV-infected patients. The case of a 37-year-old HIV-infected male diagnosed as having IgAN with proteinuria and microscopic hematuria that was successfully treated with tonsillectomy and steroid pulse therapy in combination, resulting in disappearance of urinary abnormalities (clinical remission), is reported, the first such case in the literature. A renal biopsy revealed mesangial proliferation associated with mesangial deposition of IgA and C3, consistent with IgAN. Antiretroviral therapy and angiotensin receptor blocker therapy did not improve his proteinuria. Therefore, he underwent tonsillectomy and steroid pulse therapy, and clinical remission was successfully achieved with no opportunistic infections. Clinical remission has continued for more than 3 years even after discontinuation of steroid therapy. It appears that combined treatment with tonsillectomy and steroid pulse therapy can be a good choice in managing HIV-infected patients with IgAN as long as secondary infection is strictly and continuously monitored.