title: Tubulointerstitial nephropathies in HIV-infected patients over the past 15 years: a clinico-pathological study.
abstract: OBJECTIVE
  The therapy and outcome of HIV infection have dramatically changed over the last 15 years, resulting in a change in renal complications. This study analyzed the characteristics of HIV-infected patients and biopsy-proven tubulointerstitial nephropathies to define disease patterns and therapeutic implications.
  
  
  METHODS
  A clinico-pathologic retrospective study of 59 consecutive renal biopsies showing predominant tubular and/or interstitial lesions in HIV-infected patients referred to the nephrology department between 1995 and 2011 was performed. HIV-associated nephropathy and vascular diseases were excluded from the study.
  
  
  RESULTS
  Tubulointerstitial nephropathies accounted for 26.6% of 222 native renal biopsies performed in HIV-infected patients. Two pathologic groups were analyzed, tubulopathy and interstitial nephritis, which represented 49% and 51% of tubulointerstitial nephropathies, respectively. Most patients presented with AKI (76.3%) and high-grade proteinuria (57.7%). Drug-related nephrotoxicity was the leading cause (52.5%). Alternative etiologies included infections (15.2%), dysimmune disorders (8.5%), malignancies (3.4%), and chronic (10.2%) and acute (10.2%) tubulointerstitial nephropathies of undetermined origin. Tubulopathy was strongly associated with antiretroviral drug toxicity (75.9%) and mostly caused by tenofovir (55.2%), which was associated with proximal tubular dysfunction (87.5%), overt Fanconi's syndrome (37.5%), and nephrogenic diabetes insipidus (12.5%). Interstitial nephritis was associated with a broader spectrum of pathologic lesions and etiologies.
  
  
  CONCLUSIONS
  In this series, tubulointerstitial nephropathies accounted for 26.6% of renal diseases in HIV-infected patients. Considering the therapeutic implications of diagnoses of drug toxicity, infection, and dysimmune syndromes, this study underscores the importance of monitoring renal parameters in HIV-infected patients and points to the relevance of kidney biopsy to allow an accurate diagnosis.
authors: Assistance Publique-Hôpitaux de Paris, Department of Nephrology and Dialysis, Tenon Hospital, Paris, France.
authors: Mohamad
authors: M
authors: Zaidan
authors: François-Xavier
authors: FX
authors: Lescure
authors: Isabelle
authors: I
authors: Brochériou
authors: Sarah
authors: S
authors: Dettwiler
authors: Jean-Baptiste
authors: JB
authors: Guiard-Schmid
authors: Jérôme
authors: J
authors: Pacanowski
authors: Eric
authors: E
authors: Rondeau
authors: Gilles
authors: G
authors: Pialoux
authors: Pierre-Marie
authors: PM
authors: Girard
authors: Pierre
authors: P
authors: Ronco
authors: Emmanuelle
authors: E
authors: Plaisier
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000009:adverse effects*; D001706:Biopsy; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007684:Kidney Tubules / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009395:Nephritis, Interstitial / Q000139:chemically induced / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D011507:Proteinuria / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000209:etiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents