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Diagnosis: HIV-associated Immune Complex Kidney Disease
The spectrum of disease in HIV-infected patients varies, from HIV-associated nephropathy (HIVAN), which is manifest by collapsing glomerulopathy, to usual FSGS, minimal change disease, thrombotic microangiopathy, and lupus-like HIV-immune complex kidney disease (HIVICK). Other immune complex diseases may also occur in HIV-infected patients, including IgA nephropathy and postinfectious glomerulonephritis, and are best diagnosed as those specific entities. Many authors restrict the diagnosis of HIVICK to the lupus-like lesions that are seen in some HIV-infected patients, without complete criteria of lupus. HIVICK varies in frequency depending on the population studied. In HIV-infected patients of non-African ancestry with kidney biopsy, HIVICK appears to be more frequent than HIVAN. Patients with HIVICK have varying kidney manifestations, depending on the location and extent of glomerular deposits. A minority has concurrent HIVAN lesions. Proteinuria, which may be nephrotic, hematuria, reduced GFR, and low levels of complement are common. Patients may present at any age. Prognosis appears better than for HIVAN (from: Fogo AB, et al. AJKD Atlas of Renal Pathology: HIV-Associated Immune Complex Kidney Disease (HIVICK). Am J Kidney Dis. 2016;68(2):e9-e10. [PubMed link]).
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References
- Sinclair M, Wyatt CM. Regional and Racial Disparities in HIV-Related Kidney Disease. Contrib Nephrol. 2021;199:106-113. [PubMed link]
- Kudose S, Santoriello D, Bomback AS, Stokes MB, Batal I, Markowitz GS, Wyatt CM, D'Agati VD. The spectrum of kidney biopsy findings in HIV-infected patients in the modern era. Kidney Int. 2020;97(5):1006-1016. [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; Conference Participants. 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]
- Campos P, Ortiz A, Soto K. HIV and kidney diseases: 35 years of history and consequences. Clin Kidney J. 2016;9(6):772-781. [PubMed link]
- Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKD Atlas of Renal Pathology: HIV-Associated Immune Complex Kidney Disease (HIVICK). Am J Kidney Dis. 2016;68(2):e9-e10. [PubMed link].