Associated Focal and Segmental Glomerulosclerosis in the Acquired Immunodeficiency Syndrome

Abstract

Of the 92 patients with the acquired immunodeficiency syndrome (AIDS) who were seen at our institution over a two-year period, 9 acquired the nephrotic syndrome (urinary protein greater than 3.5 g per 24 hours) and 2 had azotemia with lesser amounts of urinary protein. Five of these 11 patients had a history of intravenous-heroin addiction, but in the remaining six, there were no known predisposing factors for nephropathy. In nine patients (including the six non-addicts) the course of renal disease was marked by rapid progression to severe uremia. Renal tissue examined by biopsy in seven patients and at autopsy in three revealed focal and segmental glomerulosclerosis with intraglomerular deposition of IgM and C3. In the 11th patient, renal biopsy revealed an increase in mesangial matrix and cells, with deposition of IgG and C3 consistent with a mild immune-complex glomerulonephritis, and severe interstitial nephritis. We conclude that focal and segmental glomerulosclerosis may be associated with AIDS and suggest that rapid deterioration to uremia may characterize this renal disease.

Racial Differences in End-Stage Renal Disease Rates in HIV Infection versus Diabetes

“…In 1984, the first cases of HIV-associated nephropathy were reported, describing a form of FSGS associated with AIDS among 11 black patients in New York City. 7 Subsequent case series of kidney disease among HIV- infected patients have also primarily been composed of young black men. 8 -11 Similarly, studies using ESRD registry data demonstrate that approximately 88% of all cases of ESRD in the HIVinfected population occur among black individuals.…”

Urinary NGAL Marks Cystic Disease in HIV-Associated Nephropathy

“…1 An important complication of HIV is a form of kidney disease called HIV-associated nephropathy (HIVAN), which occurs predominantly in patients of African descent. [2][3][4] The prevalence of HIVAN may be as high as 15% of HIV patients (based upon autopsy data), and 4232 new cases of HIVAN reached ESRD between 2002 and 2006 in the United States. 5 HIVAN is a rapidly progressive form of chronic kidney disease (CKD) characterized by nephrotic range proteinuria.…”

Changing Trends in the Survival of Dialysis Patients with Human Immunodeficiency Virus in the United States

“…HIV infection is a common cause of end-stage renal disease (ESRD), especially in blacks, who develop a fulminant form of focal segmental glomerulosclerosis termed HIV-associated nephropathy (HIVAN) or AIDS nephropathy (1)(2)(3)(4)(5)(6). HIVAN has become the third most common cause of ESRD in young African Americans (7).…”