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Nephrology Dialysis Transplantation, Vol 13, Issue 4 919-923, Copyright © 1998 by Oxford University Press

ORIGINAL ARTICLES

Tissue-type plasminogen activator activity in HIV-associated HUS

M Peraldi, C Maslo, J Berrou, E Rondeau, W Rozenbaum and J Sraer
Service de Nephrologie A, Hopital Tenon, 4 rue de la Chine, F-75020 Paris, France; Service des Maladies infectieuses, Hopital Rothschild, Paris, France; Corresponding author

Background: In children, haemolytic uraemic syndrome (HUS) is associated with high plasma plasminogen activator inhibitor type 1 (PAI-1), which may contribute to the persistence of renal glomerular and arteriolar thrombi. HUS has been described in HIV-infected patients, but the pathophysiology of HUS in these patients is poorly understood. The aim of the study was to investigate plasma fibrinolytic activity in 18 patients with HIV-associated HUS. Methods: We measured tissue type plasminogen activator (t-PA) and PAI-1 activities in the plasma of 18 HIV-infected patients with biopsy-proven HUS (HIV+/HUS+0 and 48 HIV-infected patients without HUS (HIV+/HUS-). Results: Patients with HUS had a significantly higher serum creatinine, a lower platelet count and an increased incidence of cytomegalovirus (CMV) infection (72% of patients HIV+/HUS+, vs 25% of patients HIV+/HUS-). Unexpectedly, plasma PAI-1 activity was similar in both groups. However, t-PA activity was significantly higher in HUS cases (11.5 vs 4.5 U/ml, P=0.001). Patients with CMV infection, with or without HUS, had significantly increased t-PA level (P=0.01). Multivariate analysis identified high t-PA (RR=9.21) and CMV infection (RR=3.36) as risk factors for HUS. Conclusion: This study provides evidence that HIV-infected patients with HUS have high plasma t-PA activity. PAI-1 plasma activity is not significantly increased, as opposed to non-HIV-associated HUS. Thus, in the setting of HIV infection, HUS cannot be attributed to decreased fibrinolytic activity. Key words: AIDS; cytomegalovirus; fibrinolytic activity; haemolytic-uraemic syndrome
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T. I. de Silva, F. A. Post, M. D. Griffin, and D. H. Dockrell
HIV-1 Infection and the Kidney: An Evolving Challenge in HIV Medicine
Mayo Clin. Proc., September 1, 2007; 82(9): 1103 - 1116.
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