The spectrum of HIV-related nephropathy in children.
BACKGROUND
Despite the burden of human immunodeficiency virus (HIV) disease in Southern Africa, there have been few reports of HIV-related nephropathy in children. This study outlines the spectrum of HIV-1-related kidney diseases of children in KwaZulu-Natal, South Africa.


METHODS
A review of the clinical presentation, laboratory and histopathological findings of children diagnosed with HIV-related nephropathy.


RESULTS
Forty-nine out of 71 children (1-16 years old) with HIV-1 related nephropathy underwent kidney biopsy. The most common histopathological finding was focal segmental glomerulosclerosis (FSGS), which was present in 32 (65.3%) children; 13 (26.5%) having collapsing glomerulopathy and 19 (38.8%) classic FSGS. The majority of patients showed haematological (86.4%) and electrolyte abnormalities (69.4%). Renal impairment was present in 41% of patients on initial presentation. However, end-stage kidney disease was present in only 4% of these patients. All patients were treated with highly active anti-retroviral therapy (HAART), the majority (79.6%) showed decreased proteinuria with 38.8% having complete remission.


CONCLUSIONS
This study, one of the largest series of children reported from Africa, demonstrates that nephrotic syndrome due to HIV-associated nephropathy (HIVAN) is the commonest presentation of HIV-related nephropathy in childhood. Highly active anti-retroviral therapy in combination with angiotensin-converting enzyme antagonists is highly effective in decreasing proteinuria and preserving renal function.
Optics and Imaging Centre, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
Duran
D
Ramsuran
Rajendra
R
Bhimma
Pratistadevi K
PK
Ramdial
Elaene
E
Naicker
Miriam
M
Adhikari
Julian
J
Deonarain
Yetish
Y
Sing
Thajasvarie
T
Naicker
D016263:AIDS-Associated Nephropathy / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015153:Blotting, Western; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000209:etiology / Q000473:pathology; D006130:Growth Disorders / Q000209:etiology; D015658:HIV Infections / Q000453:epidemiology; D006679:HIV Seropositivity; D006801:Humans; D007223:Infant; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology; D007677:Kidney Function Tests; D008297:Male; D009404:Nephrotic Syndrome / Q000209:etiology; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
D000806:Angiotensin-Converting Enzyme Inhibitors