Glomerular lesions in HIV-infected patients: a Yale University Department of Medicine Residency Peer-Teaching Conference.
HIV-associated nephropathy (HIVAN) is a clinicopathologic entity characterized by heavy proteinuria, absence of edema and an irreversible decline in renal function. Findings on renal biopsy include: collapsed glomerular capillaries; visceral glomerular epitheliosis; microcystic tubules; mesangial prominence; and endothelial tubuloreticular inclusions. Early in the AIDS epidemic, HIVAN was the predominant glomerular lesion observed in HIV-infected patients. It is being increasingly recognized, especially in Caucasian populations, that a variety of immune complex-mediated lesions such as membranoproliferative glomerulonephritis, proliferative glomerulonephritis and IgA nephropathy are associated with HIV infection. In this review we present two cases: one patient whose first presentation of AIDS was end-stage renal disease, who on biopsy was found to have HIVAN, and the second, who was infected with HIV, and on biopsy was found to have hepatitis C-related hepatitis C related membranoproliferative glomerulonephritis. We also review the current literature on HIVAN and HIV-associated immune complex diseases (HIVICDs). Each case illustrates an important clinical point. The first that renal disease can be the first manifestation of HIV infection and the second that HIV-infected patients may develop immune complex related renal diseases, some of which may be potentially treatable.
Wrone
E M
EM
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Carey
H
H
Reilly
R F
RF
D016263:AIDS-Associated Nephropathy / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D005921:Glomerulonephritis / Q000188:drug therapy / Q000276:immunology; D005922:Glomerulonephritis, IGA / Q000276:immunology*; D005923:Glomerulosclerosis, Focal Segmental; D006526:Hepatitis C; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D008297:Male; D008875:Middle Aged