Volume 6, Number 39;  October 19 2006 - HIV-Associated Nephropathy (HIVAN) - Pathogenesis

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Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 12899589

Authors: Kimmel PL. Barisoni L. Kopp JB.

Institution: Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA.

Title: Pathogenesis and treatment of HIV-associated renal diseases: lessons from clinical and animal studies, molecular pathologic correlations, and genetic investigations. [Review] [143 refs]

Source: Annals of Internal Medicine. 139(3):214-26, 2003 Aug 5.

Abstract: HIV infection is associated with several renal syndromes, including acute renal failure. Chronic renal failure directly linked to HIV infection includes thrombotic microangiopathic renal diseases, immune-mediated glomerulonephritides, and HIV-associated nephropathy. A renal biopsy may be necessary for diagnosis. The development of HIV-associated nephropathy has been definitively linked to renal cellular infection, but the disease affects only a minority of patients, typically men of African descent. Therefore, factors determining disease expression in infected patients must now be emphasized. The pathogenic mechanisms involved in HIV-associated renal disease remain obscure. Genetic factors, as well as renal cellular responses, mediated by HIV proteins (including an immune-activated microenvironment) capable of presenting antigen in susceptible hosts probably explain most cases. HIV-associated nephropathy has a characteristic pathologic phenotype, including glomerular, tubular, and interstitial changes, and ultrastructural findings. Infection of the glomerular epithelial cell, or podocyte, and consequent structural and biochemical changes may be pivotal in pathogenesis. The HIV-1 transgenic mouse is an important model for understanding disease pathogenesis, particularly the role of HIV proteins in mediating renal tissue injury. Rigorously controlled randomized trials have not evaluated treatment, but corticosteroids and angiotensin-converting enzyme inhibitors have been used. Highly active antiretroviral therapy seems to have decreased the incidence of end-stage renal disease related to HIV infection and, in case reports, to have improved renal functional and pathologic outcomes of HIV-associated nephropathy. Outcomes in patients undergoing hemodialysis and peritoneal dialysis have improved, and current research focuses on renal transplantation for treatment of HIV-infected patients. [References: 143]

Publication Type: Congresses. Review.

 Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 15915314

Authors: Lu TC. Ross M.

Institution: Mount Sinai Hospital, Department of Nephrology, Box 1243, One East 100th Street, New York, NY 10029, USA.

Title: HIV-associated nephropathy: a brief review. [Review] [43 refs]

Source: Mount Sinai Journal of Medicine. 72(3):193-9, 2005 May.

Abstract: HIV-associated nephropathy (HIVAN) is an important cause of renal failure in HIV-1 seropositive patients. The disease is characterized by collapsing focal segmental glomerulosclerosis with marked podocyte proliferation, microcystic dilatation of the tubules and interstitial nephritis. Patients generally present with advanced HIV-1 infection, renal insufficiency and marked proteinuria. No serologic markers exist to diagnose HIVAN, and given the broad differential diagnosis for renal failure in these patients, renal biopsy should be performed. Viral infection of renal cells plays a central role in the pathogenesis of HIVAN. There is now compelling evidence that highly active antiretroviral therapy (HAART) is effective in preventing end-stage renal disease in patients affected with HIVAN. The efficacy of angiotensin-converting enzyme (ACE) inhibitors and prednisone has also been evaluated, but larger prospective studies are needed. [References: 43]

Publication Type: Journal Article. Review.

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 12675837

Authors: Weiner NJ. Goodman JW. Kimmel PL.

Institution: Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University Medical Center, Washington, D.C. 20037, USA.

Title: The HIV-associated renal diseases: current insight into pathogenesis and treatment. [Review] [139 refs]

Source: Kidney International. 63(5):1618-31, 2003 May.

Abstract: Since the description of a new renal syndrome in patients with the acquired immunodeficiency syndrome (AIDS) in the middle 1980s, much has been learned regarding the association of human immunodeficiency virus (HIV) infection and renal disease. The HIV-associated renal diseases represent a spectrum of clinical and histopathologic conditions. In this review, epidemiologic and clinical aspects of HIV-associated renal diseases are presented. Particular attention is placed on the pathologic and pathophysiologic mechanisms involved in HIV-associated focal glomerulosclerosis, immune complex-mediated disease, and thrombotic microangiopathies. Pharmaceutical treatment options, including the use of glucocorticoids, angiotensin-converting enzyme (ACE) inhibitors, and highly active antiretroviral therapy, are discussed. The therapeutic option of renal transplantation is presented, with insight into new clinical and basic research supporting a possible role of immunosuppressive therapy in this already immunocompromised patient population. [References: 139]

Publication Type: Journal Article. Review.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth