The spectrum of kidney disease in patients with AIDS in the era of antiretroviral therapy.
With prolonged survival and aging of the HIV-infected population in the era of antiretroviral therapy, biopsy series have found a broad spectrum of HIV-related and co-morbid kidney disease in these patients. Our study describes the variety of renal pathology found in a prospective cohort of antiretroviral-experienced patients (the Manhattan HIV Brain Bank) who had consented to postmortem organ donation. Nearly one-third of 89 kidney tissue donors had chronic kidney disease, and evidence of some renal pathology was found in 75. The most common diagnoses were arterionephrosclerosis, HIV-associated nephropathy and glomerulonephritis. Other diagnoses included pyelonephritis, interstitial nephritis, diabetic nephropathy, fungal infection and amyloidosis. Excluding 2 instances of acute tubular necrosis, slightly over one-third of the cases would have been predicted using current diagnostic criteria for chronic kidney disease. Based on semi-quantitative analysis of stored specimens, pre-mortem microalbuminuria testing could have identified an additional 12 cases. Future studies are needed to evaluate the cost-effectiveness of more sensitive methods for defining chronic kidney disease, in order to identify HIV-infected patients with early kidney disease who may benefit from antiretroviral therapy and other interventions known to delay disease progression and prevent complications.
Wyatt
Christina M
CM
Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. christina.wyatt@mssm.edu
Morgello
Susan
S
Katz-Malamed
Rebecca
R
Wei
Catherine
C
Klotman
Mary E
ME
Klotman
Paul E
PE
D'Agati
Vivette D
VD
D016263:AIDS-Associated Nephropathy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005921:Glomerulonephritis; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis; D011446:Prospective Studies; D014019:Tissue Donors
D019380:Anti-HIV Agents