Sonography as a predictor of human immunodeficiency virus-associated nephropathy.
OBJECTIVE
To determine whether renal sonography can be used to predict the pathologic diagnosis of human immunodeficiency virus-associated nephropathy.


METHODS
This cross-sectional study evaluated 87 human immunodeficiency virus-positive patients who underwent both kidney biopsy and renal sonography after referral to the Johns Hopkins Renal Clinic from January 1995 to July 2002. Using a standardized measure of echogenicity, an independent blinded radiologist reviewed the original sonographic images. Sensitivity, specificity, positive and negative predictive values, receiver operating characteristic curves, and likelihood ratios were determined with the use of the biopsy pathologic report as the criterion standard.


RESULTS
Thirty-four patients (39%) had biopsy-proved human immunodeficiency virus-associated nephropathy. A higher serum creatinine level, greater proteinuria, and black race were associated with human immunodeficiency virus-associated nephropathy, whereas age, sex, hypertension, and diabetes were not. Sensitivity and specificity for the highest 2 levels of echogenicity were 96% and 51%, respectively Sensitivity and specificity for the highest level of echogenicity were 40% and 95%. The likelihood ratio for the diagnosis of human immunodeficiency virus-associated nephropathy on the basis of the highest echogenicity score was 7.4 (95% confidence interval, 1.3-73.0; P = .006). The likelihood ratio for the lowest 2 echogenicity scores was 0.08 (95% confidence interval, 0.002-0.57; P = 0.003). Kidney size was not associated with human immunodeficiency virus-associated nephropathy status.


CONCLUSIONS
This study provides evidence that, among patients with human immunodeficiency virus and kidney disease, the highest and lowest levels of sonographic echogenicity have diagnostic value in respectively establishing or excluding human immunodeficiency virus-associated nephropathy.
Atta
Mohamed G
MG
Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA. matta1@jhmi.edu
Longenecker
J Craig
JC
Fine
Derek M
DM
Nagajothi
Nagapradeep
N
Grover
Davinder S
DS
Wu
Jean
J
Racusen
Lorraine C
LC
Scheel
Paul J
PJ
Hamper
Ulrike M
UM
D016263:AIDS-Associated Nephropathy / Q000000981:diagnostic imaging*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography