Minimal change disease in human immunodeficiency virus combined with monoclonal gammopathy of uncertain significance: A case report

Previous studies have demonstrated the significant increase in the prevalence of monoclonal gammopathy (MG) among individuals with human immunodeficiency virus (HIV), although the exact mechanism remains unclear. Both HIV and MG contribute to renal injury, which has garnered increasing attention. We presented a case of a newly diagnosed HIV patient with co-morbid MG and subsequent or concurrent massive proteinuria. A 61-year-old male with newly diagnosed HIV (viral load: 9.3 × 10 4 IU/mL; CD4 count: 0.18 × 10 9 /L) presented with MG (serum M-spike: 2.34 g/dL, monoclonal IgG kappa) and concurrent nephrotic-range proteinuria (3.79 g/day). The renal biopsy revealed minimal change disease (MCD), but did not provide sufficient evidence to support the hypothesis that MG led to renal injury (negative immunofluorescence, no electron-dense deposits). Following alone treatment with highly active antiretroviral therapy, the viral ribonucleic acid became undetectable in plasma, and complete remission of nephropathy was achieved. Furthermore, there was no significant improvement in MG. In our case, we speculated that there might be an association between MCD and HIV. However, for MG of undetermined significance (MGUS), longer follow-up surveillance is necessary to establish the clearer relationship among the three.