HIV-associated nephropathy
| HIV-associated nephropathy | |
|---|---|
| Specialty | Nephrology |
HIV-associated nephropathy (HIVAN) refers to
AIDS. The most common, or "classical", type of HIV-associated nephropathy is a collapsing focal segmental glomerulosclerosis (FSGS), though other forms of kidney disease may also occur.[1] Regardless of the underlying histology, kidney disease in HIV-positive patients is associated with an increased risk of death.[2]
Cause
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 of
cytokines during HIV infection. Usually occurs only in advanced HIV disease and approximately 80% of patients with HIVAN have a CD4 count of less than 200. HIVAN presents with nephrotic syndrome and progressive kidney failure. Despite being a cause of chronic kidney failure, kidney sizes are usually normal or large.[citation needed
]
Pathology
Abnormalities involve all components of the
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 to chronic kidney disease.[citation needed
]
Treatment
There are no adequate data from randomised controlled trials.[citation needed]
Treatment with
angiotensin 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 that ciclosporin 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]
Incidence
HIVAN is the third most common cause of end stage
biopsies performed in HIV positive patients.[citation needed
]