Nephropathology Since 2006
   
Case 159
Diagnosis
 
     
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Diagnosis: Human Immunodeficiency Virus (HIV)-Associated Nephropathy (HIVAN)

Despite the decreased incidence of human immunodeficiency virus (HIV)-associated nephropathy due to the widespread use of combined active antiretroviral therapy, it remains one of the leading causes of end-stage renal disease (ESRD) in HIV-1 seropositive patients. Patients usually present with low CD4 count, high viral load and heavy proteinuria, with the pathologic findings of collapsing focal segmental glomerulosclerosis. Increased susceptibility exists in individuals with African descent, largely due to polymorphism in APOL1 gene. Other clinical risk factors include high viral load and low CD4 count. Advanced kidney disease and nephrotic range proteinuria have been associated with progression to ESRD. Improvement in kidney function has been observed after initiation of combined active antiretroviral therapy. Other treatment options, when clinically indicated, are inhibition of the renin–angiotensin system and corticosteroids. In patients with progression to ESRD, kidney transplant should be pursued, provided that viral load control is adequate (Palau L, et al. HIV-associated nephropathy: links, risks and management. HIV AIDS (Auckl). 2018;10:73-81. [PubMed link]).

See the chapter: Focal and Segmental Glomerulosclerosis of our Tutorial (Only Spanish version).

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References

  • Verma B, Singh A. Histological spectrum of renal disease in HIV/AIDS patients with significant proteinuria: An Indian perspective. J Family Med Prim Care. 2019;8(3):860-865. [PubMed link]
  • Wearne N, Swanepoel CR, Duffield MS, Davidson BJ, Manning K, Tiffin N, Boulle A, Rayner BL, Naidu P, Okpechi IG. The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa. BMC Nephrol. 2019;20(1):44. [PubMed link]
  • Katuri A, Bryant JL, Patel D, Patel V, Andhavarapu S, Asemu G, Davis H, Makar TK. HIVAN associated tubular pathology with reference to ER stress, mitochondrial changes, and autophagy. Exp Mol Pathol. 2019;106:139-148. [PubMed link]
  • Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA, Atta MG. HIV-associated nephropathy: links, risks and management. HIV AIDS (Auckl). 2018;10:73-81. [PubMed link]
  • Rednor SJ, Ross MJ. Molecular Mechanisms of Injury in HIV-Associated Nephropathy. Front Med (Lausanne). 2018;5:177. [PubMed link]
  • Swanepoel CR, Atta MG, D'Agati VD, Estrella MM, Fogo AB, Naicker S, Post FA, Wearne N, Winkler CA, Cheung M, Wheeler DC, Winkelmayer WC, Wyatt CM. Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2018;93(3):545-559. [PubMed link]
  • Hou J, Nast CC. Changing concepts of HIV infection and renal disease. Curr Opin Nephrol Hypertens. 2018;27(3):144-152. [PubMed link]

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