title: Observations on a cohort of HIV-infected patients undergoing native renal biopsy.
abstract: OBJECTIVE
  This study aims to explore the spectrum of renal disease in HIV-infected patients, identify clinical predictors of HIV-associated nephropathy (HIVAN), and investigate the performance of renal biopsy in HIV-infected patients.
  
  
  METHODS
  Of 263 HIV-infected patients with renal disease evaluated between 1995 and 2004, 152 had a renal biopsy, while 111 had not. A group comparison was performed.
  
  
  RESULTS
  The leading biopsy diagnoses were HIVAN (35%), noncollapsing focal segmental glomerulosclerosis (22%), and acute interstitial nephritis (7.9%), amongst over a dozen others. There was a trend of decreasing yearly incidence of HIVAN diagnoses, paralleling the use of antiretroviral therapy. By multivariate logistic regression, CD4 counts >200 cells/mm(3) and higher estimated glomerular filtration rate were strong negative predictors of HIVAN. HIVAN patients were more likely to require dialysis (p < 0.0001) and had worse overall survival (p = 0.02). Younger age and lower estimated glomerular filtration rate were significant predictors of renal biopsy in multivariate regression analysis. More biopsied patients progressed to dialysis (51 vs. 25%, p = 0.001) and death (15 vs. 5.4%, p = 0.001), despite more frequent corticosteroid treatment (29 vs. 3.6%, p = 0.001).
  
  
  CONCLUSIONS
  These findings may reflect more severe acute and/or chronic disease at the time of biopsy and suggests that earlier renal biopsy may be warranted in HIV-infected patients, especially in light of the changing spectrum of renal disease in this group.
authors.affiliation: Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Berliner
authors.forename: Derek M
authors.initials: DM
authors.lastname: Fine
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.forename: M Hafizur
authors.initials: MH
authors.lastname: Rahman
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Racusen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Scheel
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000473:pathology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies