Evolving Spectrum of HIV-Associated Nephropathy

Abstract

Background: The profile of renal pathology in HIV patients is undergoing significant changes in pattern in the HAART era, with the incidence of HIV-associated nephropathy (HIVAN) decreasing and the incidence of non-HIVAN lesions increasing. Case Reports: We describe 2 cases of HIV-infected patients diagnosed with diffuse infiltrative lymphocytosis syndrome (DILS) and coexistent multiple myeloma, an association that has heretofore been unreported. The cases involve a 23-year-old man and a 54-year-old man who presented with renal failure and proteinuria. Kidney biopsy in both revealed DILS and further evaluation revealed both to have multiple myeloma. Conclusion: DILS is a late complication of AIDS that has become extremely rare in the United States during the HAART era. However, there are patients who present without an AIDS-defining illness or cancers. The development of multiple myeloma in the setting of HIV and DILS presents a novel, heretofore unreported association that may be important to recognize in HIV/AIDS patients with kidney failure.

Trends in the outcomes of end-stage renal disease secondary to human immunodeficiency virus-associated nephropathy

“…Since HIV replicates in kidney epithelial cells [7], viral load reduction would be expected to minimize the direct effect of the virus on disturbing kidney function. In addition, it appears to us that in recent years fewer patients with HIV and kidney disease have presented with the classic features of HIVAN, but increasingly with other phenotypes like focal-segmental glomerulosclerosis alone, or interstitial nephritis, or other pathologies [8]. Whether this is the case and to what extent cannot be determined using the data we have available.…”

Diffuse Infiltrative Lymphocytosis Syndrome: A Case With Multiple Extra-Glandular Infiltrations

“…In our case, the patient was not taking any medication prior to his hospital stay. Frequently reported medications are antiretroviral drugs, antibiotics, proton pump inhibitors, NSAIDs and allopurinol [15]. Other possible causes include infections (pyelonephritis and mycobacterial infection), systemic diseases (such as malignancy) and, more specifically in HIV individuals, the immune reconstitution inflammatory syndrome (IRIS) and the DILS [16].…”

The diffuse infiltrative lymphocytosis syndrome (DILS). A comprehensive review

“…It might present as acute kidney injury, distal tubular acidosis, mild grade tubular proteinuria, leucocyturia, haematuria, polyuria with inappropriate diuresis, and/or nephromegaly [22]. Type IV renal tubular acidosis from hyporeninemic hypoaldosteronism has also been described [23].…”