The HIV-associated renal diseases: current insight into pathogenesis and treatment.
Since the description of a new renal syndrome in patients with the acquired immunodeficiency syndrome (AIDS) in the middle 1980s, much has been learned regarding the association of human immunodeficiency virus (HIV) infection and renal disease. The HIV-associated renal diseases represent a spectrum of clinical and histopathologic conditions. In this review, epidemiologic and clinical aspects of HIV-associated renal diseases are presented. Particular attention is placed on the pathologic and pathophysiologic mechanisms involved in HIV-associated focal glomerulosclerosis, immune complex-mediated disease, and thrombotic microangiopathies. Pharmaceutical treatment options, including the use of glucocorticoids, angiotensin-converting enzyme (ACE) inhibitors, and highly active antiretroviral therapy, are discussed. The therapeutic option of renal transplantation is presented, with insight into new clinical and basic research supporting a possible role of immunosuppressive therapy in this already immunocompromised patient population.
Weiner
Neil J
NJ
Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University Medical Center, Washington, D.C. 20037, USA.
Goodman
Jeffrey W
JW
Kimmel
Paul L
PL
D016263:AIDS-Associated Nephropathy / Q000188:drug therapy* / Q000209:etiology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy / Q000821:virology; D017582:Renal Replacement Therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D019380:Anti-HIV Agents; D005938:Glucocorticoids