Renal manifestations of sexually transmitted diseases: sexually transmitted diseases and the kidney.
The adolescent population is particularly vulnerable to STDs. Those that cause significant kidney disease are of viral origin. The primary VVD are HIV-1, HBV, and HCV. Screening of high-risk populations should include quantitation of proteinuria, including total protein and microalbumin, to assess severity of renal damage and potential for progression. Renal biopsy is indicated for diagnosis and for planning important treatment interventions if there is significant proteinuria or decreased renal function. Causes of acute renal failure are frequently reversible and should be treated aggressively. These include HUS, vaso-motor or ischemic acute tubular necrosis, and drug toxicities. The spectrum of chronic kidney disease associated with VVD is broad and may include systemic manifestations of vasculitis. HIV-associated nephropathy is the prototype, with the most prevalent lesion remaining FSGS. Progression occurs in up to 15% of the patients, who are overwhelmingly of African lineage. Significant advances in management include ongoing development of HAART, angiotensin antagonists to control proteinuria, and novel immune-modulating drugs such as MMF, CsA, and rituximab. Dialysis therapies have offered improved survival, especially in pediatric patients. Moreover, transplantation is no longer considered experimental and should be offered to select patients.
Abitbol
Carolyn L
CL
Department of Pediatrics, Division of Pediatric Nephrology, University of Miami/Holtz Children's Hospital, Miami, FL 33101, USA. cabitbol@med.miami.edu
Friedman
Lawrence B
LB
Zilleruelo
Gastón
G
D000293:Adolescent; D003404:Creatinine / Q000378:metabolism; D005919:Glomerular Filtration Rate; D005923:Glomerulosclerosis, Focal Segmental / Q000821:virology; D015658:HIV Infections / Q000150:complications; D006509:Hepatitis B / Q000276:immunology; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000276:immunology / Q000821:virology*; D011507:Proteinuria / Q000209:etiology; D006435:Renal Dialysis; D012749:Sexually Transmitted Diseases / Q000150:complications* / Q000276:immunology / Q000821:virology; D016482:Urinalysis
D003404:Creatinine