| HIV-associated nephropathy | |
|---|---|
| Specialty | Nephrology |
HIV-associated nephropathy (HIVAN) refers tokidney disease developing in association with infection byhuman immunodeficiency virus, the virus that causesAIDS. The most common, or "classical", type of HIV-associated nephropathy is a collapsingfocal segmental glomerulosclerosis (FSGS), though other forms of kidney disease may also occur.[1] Regardless of the underlyinghistology, kidney disease in HIV-positive patients is associated with an increased risk of death.[2]
HIVAN may be caused by direct infection of the kidney cells by HIV, with resulting kidney damage through the viral gene products. It could also be caused by the release ofcytokines during HIV infection. Usually occurs only in advanced HIV disease and approximately 80% of patients with HIVAN have aCD4 count of less than 200. HIVAN presents withnephrotic syndrome and progressivekidney failure. Despite being a cause of chronic kidney failure, kidney sizes are usually normal or large.[citation needed]
Abnormalities involve all components of thenephron. Typical findings are that of collapsing capillary loops, areas of scarring called focal segmental glomerulosclerosis (FSGS), microcystic tubular dilatation that is highly echogenic, and prominent podocytes.The characteristic feature of collapsing glomerulopathy is collapse of glomerular tuft and proliferation and hyperplasia of glomerular visceral epithelial cells. Its prognosis is always poor, as it rapidly progresses tochronic kidney disease.[citation needed]
There are no adequate data from randomised controlled trials.[citation needed]
Treatment withhighly active antiretroviral therapy andangiotensin converting enzyme inhibitors orangiotensin receptor blockers has been shown to be beneficial and should be given to all patients unless otherwise contraindicated. General renoprotective measures and the treatment of the complications of nephrotic syndrome and kidney failure are adjunctive.[citation needed]
Corticosteroid treatment can be useful in patients who do not respond to initial treatment. There is some evidence thatciclosporin might be helpful in selective cases, however further study of both steroids and ciclosporin is needed before these types of drugs can be considered standard treatment.[citation needed]
HIVAN is the third most common cause of end stagekidney failure among African Americans, and commonly seen in African-American patients with HIV compared to other ethnic groups. In the USA 12% of patients dying with AIDS have histologically proven HIVAN, the worldwide incidence amongst AIDS patients appears to be similar. A South African study atTygerberg Hospital,Stellenbosch University, has shown HIVAN histology in 33/61(54%)biopsies performed in HIV positive patients.[citation needed]
