HIV associated nephropathy

HIV associated nephropathy

Serious renal complication of advanced HIVinfection and AIDSleading to chronic and eventually end stage renal failure(ESRF). HIVAN is caused by direct infection of the renal cells with the HIV-1 virus and leads to renal damage through the viral gene products.

Usually occurs only in advanced disease and approximately 80% of patients with HIVAN have a CD4count of less than 200. HIVAN presents with nephrotic syndromeand progressive renal failure. Despite being a cause of chronic renal failure kidney sizes are usually normal or large.

Incidence

Much more common in Black and African American patients with HIV. In the USA 12% of patients dying with AIDShave histologically proven HIVAN, the worldwide incidence amongst AIDSpatients appears to be similar. A South African study at Tygerberg Hospital, Stellenbosch University, has shown HIVAN histology in 33/61(54%) biopsiesperformed in HIV positive patients.

Among black adults in the USA it is the third most common cause of ESRF.

Pathology

Involves all components of the nephron. Typical findings are that of collapsing FSGS(Focal segmental glomerulosclerosis)and mycrocystic tubular dilatation.

Treatment

There is as yet inadeqaute data from randomised controlled trials.

Treatment with HAARTand ACE inhibitors/Angiotensin receptor blockershas been shown to be beneficial and should be given to all patients unless otherwise contra-indicated. General renoprotective measures and the treatment of the complications of nephrotic syndrome and renal failure are adjunctive.

Corticosteroidtreatment can be useful in patients who do not respond to the above treatment. There is some evidence that cyclophosphamidemight be helpful in selective cases, however further trials are required on both steroids and cyclophosphamidebefore these drugs can become standardised treatmen if at all.

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/HIV+associated+nephropathy Wikipedia article HIV associated nephropathy.