Page 331 - Abstract Book KONIKA 18

Nephrology

P-NEP-025
A Rapid Kidney Function Decline in A Child with HIV
with An Undetectable Viral Load: A Case Report

Andini Rizayana, Eka L. Hidayati, Cahyani G. Ambarsari, Dina Muktiarti,
Meilania Saraswati, Henny A. Puspitasari
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. ipto Mangunkusumo General Hospital,
Jakarta, Indonesia

Abstract
Background HIV-associated nephropathy and classical collapsing focal segmental glomerulosclerosis have
been recognized as the common forms of kidney diseases in the setting of HIV, both of which can progress
rapidly to kidney failure. In the recent years, a wide spectrum of histopathological findings of HIV-associated
kidney disease have been reported. Objective To demonstrate that rapid progression of kidney disease can
still occur in HIV-infected children despite an undetectable viral load. Case A 12-year-old girl with HIV
stage 2 presented with acute nephritic syndrome. She was diagnosed with HIV since the age of 3.5 years
and was first treated with HAART regimen consisted of zidovudine, lamivudine, and efavirenz. Due to
treatment failure, the regimen was changed to tenofovir, lamivudine, and lopinavir/ritonavir and achieved
an undetectable viral load. On admission, she had hypertension, diminished kidney function (eGFR 62
mL/min per 1.73 m2), hypoalbuminemia, nephrotic-range proteinuria, haematuria, and serum electrolyte
abnormalities (hypokalemia, hypocalcemia, hypophosphatemia, and hypomagnesemia), which were suspected
caused by tenofovir. Subsequently, HAART was converted to abacavir, lopinavir/ritonavir, and lamivudine.
She was tested negative for HBV and HCV, with low C3, normal C4, positive ANA, and slightly increased
antids-DNA. Histopathology revealed mesangioproliferative glomerulonephritis (MPGN) with crescent
formation, diffuse endocapillary and mesangial proliferation, and tubular atrophy. Immunofluorescence was
negative for IgA and IgG, but was positive for C1q (1+). Despite optimal treatment, her hospital course was
complicated with sepsis. Consequently, her kidney function continued to deteriorate and reached end-stage
kidney disease. Conclusion HIV-related MPGN may still occur in HIV-infected children despite excellent
HAART and that the disease manifestations may differ from those reported in previous studies.
Keywords: human immunodeficiency virus; kidney disease; kidney failure; hematuria; proteinuria;
membranoproliferative glomerulonephritis; highly active antiretroviral therapy

P-NEP-026
Recurrent positivity of SARS-CoV-2 RNA
in Children with End Stage Renal Disease

Martinus Nuherwan Desyardi, Kristia Hermawan
Department of Child Health, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada/
Dr. Sardjito General Hospital, Yogyakarta, Central Java, Indonesia
Abstract
Background The emergence of coronavirus disease 2019 (COVID-19), caused by the novel severe acute
respiratory syndrome coronavirus-2 (SARS-CoV-2), has evolved into a global pandemic. Prolonged positivity
of nucleic acid amplification tests (NAAT) in children were rarely reported. We report a case of end stage
renal disease (ESRD) with recurrent positivity of NAAT for SARS-CoV-2 RNA. Objective To determine
reinfection or recurrent positivity of SARS-CoV-2 RNA in children with ESRD. Case A 16-year-old girl was
diagnosed with ESRD since March 2021. She was under twice weekly haemodialysis at Sardjito Hospital.
On 18th May 2021, patient began to experience fever and cough and nasopharyngeal swab came positive for
SARS-CoV-2 RNA. The patient was informed to begin home quarantine for 14 days. After home quarantine,
the symptoms persisted accompanied with tachypnoea. The patient visited to emergency room of Sardjito and
assessed with COVID-19 infection with moderate symptoms. The NAAT evaluation showed positive (CT
value of Gen ORF 31). The patient was admitted 5 days with standard therapy. After discharged, the NAAT
was conducted consecutively on June 12, 2021; July 1, 2021; and July 11, 2021; with CT value of Gen ORF
result 35.9, 20.6, and 35.5, respectively. The recurrent positivity of SARS-CoV-2 RNA was persisted until
63 days with one time trend of declining CT value. The patient had similar symptoms while the CT value
trend were declining. Therefore, the patient was readmitted. Conclusion Whether the case was reinfection
or recurrent positivity of SARS-CoV-2 RNA need to be elucidated.
Keywords: COVID-19; end-stage kidney disease.

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