title: Malignant hypertension in HIV-associated glomerulonephritis.
abstract: BACKGROUND
  Glomerular diseases other than HIVAN (HIV-associated nephropathy) are common among HIV patients but the information about their clinical characteristics and prognosis is very scarce. We have observed several HIV patients with glomerulonephritis in whom malignant hypertension (MHT) was the first clinical manifestation.
  
  
  METHODS
  All HIV-infected individuals with a biopsy-proven glomerulonephritis at our hospital were reviewed. Information about clinical characteristics, histopathologic data and outcome was collected. The incidence of MHT among HIV and non-HIV patients with glomerulonephritis was studied.
  
  
  RESULTS
  Thirty HIV patients with glomerulonephritis were identified. Ten of them (33%) presented with MHT (severe hypertension and grade III hypertensive retinopathy). In comparison with patients without MHT, they showed a significantly higher blood pressure at presentation, a higher finding of IgA nephropathy (50% versus 15%; P < 0.05) and of malignant nephrosclerosis (60% versus 0%; P < 0.05) in renal biopsies, a higher viral load and a lower CD4+ cell count at the end of follow-up and a worse patient and renal survival: six patients (60%) started chronic dialysis and seven (70%) died after a follow-up of 11.8 +/- 16.2 and 39 +/- 35 months, respectively. Co-infection by HCV (hepatitis C virus) and HBV (hepatitis B virus) was very frequent among patients with malignant hypertension. The incidence of malignant hypertension among non-HIV patients with glomerulonephritis was significantly lower than that among HIV-infected patients.
  
  
  CONCLUSIONS
  Malignant hypertension is a common presentation of patients with HIV-associated glomerulonephritis, particularly in those with IgA nephropathy, and is associated with a very poor patient and renal survival.
authors.affiliation: Servicio de Nefrología, Hospital 12 de Octubre, Avda, Andalucía s/n, 28041 Madrid, Spain. emoralesr@senefro.org
authors.forename: Enrique
authors.initials: E
authors.lastname: Morales
authors.forename: Elena
authors.initials: E
authors.lastname: Gutierrez-Solis
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gutierrez
authors.forename: Roberto
authors.initials: R
authors.lastname: González
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martínez
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000473:pathology; D006801:Humans; D006974:Hypertension, Malignant / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006977:Hypertension, Renal / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents