Nephropathology
   
Case 31
Diagnosis
 
     
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Diagnosis: Membranous glomerulonephritis, stage I, associated to HIV infection

The most frequent cause of nephrotic syndrome in HIV-infected patients is the disorder now known as HIV-associated nephropathy (HIVAN). This condition has characteristic clinical and pathological manifestations. HIVAN is a nephropathy with glomerular, tubular, and interstitial changes.

However, many other glomerulopathies have been described in HIV-infected patients. Most of them are immune complex mediated; their incidence is dependent on age and geographic and racial factors. Furthermore, the types of lesions may be associated with the coexistence of other infections as hepatitis B and C, bacterial infections and other viruses. The most frequent include IgA nephropathy, membranous GN, and membranoproliferative GN. The pathogenesis of these GN with glomerular immune complex deposition is not clear, it is possible that HIV-antigen-containing immune complexes are deposited un glomeruli, but it is also possible that other mechanisms are involved.

Membranous nephropathy may be a highly steroid-responsive lesion in the HIV-infected patient, and treatment may help avert the need for dialysis in a patient population that generally has a poor outcome on dialysis (Mattana J, et al. AIDS-associated membranous nephropathy with advanced renal failure: response to prednisone. Am J Kidney Dis. 1997;30(1):116-9.) [PubMed link]).

See the chapter Membranous Glomerulonephritis of our Tutorial, with atlas and text (English version).

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References

  • Haas M, Kaul S, Eustace JA. HIV-associated immune complex glomerulonephritis with "lupus-like" features: a clinicopathologic study of 14 cases. Kidney Int. 2005;67(4):1381-90. [PubMed link]
  • Alarcón-Zurita A, Salas A, Antón E, Morey A, Munar MA, Losada P, Martinez J. Membranous glomerulonephritis with nephrotic syndrome in a HIV positive patient--remarkable remission with triple therapy. Nephrol Dial Transplant. 200l;15(7):1097-8. [PubMed link][Free full text]
  • Cheng JT, Anderson HL Jr, Markowitz GS, Appel GB, Pogue VA, D'Agati VD. Hepatitis C virus-associated glomerular disease in patients with human immunodeficiency virus coinfection. J Am Soc Nephrol. 1999;10(7):1566-74.[PubMed link][Free full text]
  • Mattana J, Siegal FP, Schwarzwald E, Molho L, Sankaran RT, Gooneratne R, Ahuja TS, Singhal PC. AIDS-associated membranous nephropathy with advanced renal failure: response to prednisone. Am J Kidney Dis. 1997;30(1):116-9. [PubMed link]
  • Gonzalo A, Navarro J, Rivera M, Ortuño J. Membranous nephropathy associated with hepatitis C virus infection and human immunodeficiency virus disease. Nephron. 1994;67(2):248-9.[PubMed link]
  • Kimmel PL, Phillips TM, Ferreira-Centeno A, Farkas-Szallasi T, Abraham AA, Garrett CT. HIV-associated immune-mediated renal disease. Kidney Int. 1993;44(6):1327-40. [PubMed link]
  • Korbet SM, Schwartz MM. Human immunodeficiency virus infection and nephrotic syndrome. Am J Kidney Dis. 1992;20(1):97-103. [PubMed link]

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