Histological spectrum of renal disease in HIV/AIDS patients with significant proteinuria: An Indian perspective

Abstract

Background: Chronic kidney disease (CKD) has become epidemic in HIV/AIDS patients across Western and Eastern countries. HIV-associated nephropathy (HIVAN) has been consistently reported in studies from North America, Europe and African countries. However, studies from Asian countries are very sparse and differ strikingly in histological spectrum of renal disease, particularly in presence of HIVAN. Objectives: The study was carried out to in a teaching hospital from India to delineate the histological spectrum of renal disease and detect presence HIVAN in those with significant proteinuria (≥1gm/day). Patients and Methods: Urine analysis was done in 510 consecutive hospitalised HIV/AIDS patients after screening 640 such patients with age >18years. Patients with dipstick proteinuria ≥1+ were subjected to 24-hour urinary protein estimation. Renal biopsy was done in 10 patients with proteinuria ≥1gm/day. Results: Dipstick proteinuria ≥1+ was present in 29% patients. In patients undergoing kidney biopsy, the most frequent glomerular lesion was mesangial proliferative glomerulonephritis (30%) followed by HIVAN (20%). Tubulo-interstitial lesions were seen in 60% of biopsies. Pooled analysis of all the available kidney biopsy series from India revealed prevalence of HIVAN to be 16.5%. Conclusion: Contrary to the popular belief, HIVAN appears to be a common entity in this part of world too. High degree of clinical suspicion is required as diagnosis of HIVAN caries higher morbidity and mortality. Moreover, an early diagnosis and timely management can improve prognosis in such patients.

Histopathological Pattern of Kidney Diseases Among HIV-Infected Treatment-Naïve Patients in Kano, Nigeria

“…However, a pooled analysis of data from 10 studies in India showed that HIVAN constituted 16.5%, followed by mesangioproliferative glomerulonephritis (MPGN) 13.9%, FSGS 7.7% and tubulointerstitial lesions 22.7% among other histologic diagnoses. 23 Though this prevalence of HIVAN is lower than what we found in this study, the wide variation in the histopathologic findings is similar to that of our study.…”

“…12 In this study, tubulointerstitial disease was seen in only 15% of our patients; and although higher than the 7.9% reported by Berliner et al, it is lower than the 27.7% and the 41% reported from India and Kenya respectively. 23 , 24 Concurrent medications, use of herbal concoctions and infections, among other causes, may underlie the reasons for the high frequency of tubulointerstitial disease among these patients. A number of immune complex diseases have also been described in the setting of HIV, including IgA nephropathy, lupus-like glomerulonephritis (GN), membranous glomerulopathy, post-infectious GN, mesangiocapillary GN and the “ball-in-cup” phenomenon.…”

HIV-Associated Nephropathy in 2022

“…From a global standpoint, several countries follow the decreased incidence of HIVAN with some nations such as Italy, Thailand [13], and Australia [14] even reporting a complete absence of HIVAN in kidney biopsies, in contrast to South African patients diagnosed with HIV, where the most common KB finding was HIVAN [15], especially considering that the highest HIV rates (>7%) are of South African nations [16]. Despite the drastic global decline in HIVAN incidence, there are still geographical disparities.…”

The Association between Serum Creatinine, HIV-Infection and Metabolic Variables in Patients Living with Diabetes Mellitus

“…Without treatment, CKD can progress to ESRD within weeks to months [15]. Although the prevalence of presumed HIVAN is declining since the introduction of cART (combined Antiretroviral Therapy) [16], DM+HIV+ patients are still at greater risk of developing CKD 12 when compared to those DM+ or HIV+ patients or those having no co-morbidities (DM-HIV). Pillay et al found that DM+HIV+ patients had significantly poorer blood sugar control than those with DM alone [17].…”