HIV-related nephropathy: A South African perspective

Abstract

Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of renal failure in those of African origin. A number of other kidney diseases occur in HIV-positive patients. We conducted a retrospective review of renal biopsies in HIV-positive Black African patients to determine the prevalence of both 'classic HIVAN' and non-HIVAN pathologies in this group. Clinical and laboratory data from HIV-positive patients who underwent renal biopsy from 1st January 2003 to 31st December 2004 were collected. Similar information on HIV-negative patients biopsied during the same period was also recorded by way of comparison to try and assess the influence of the virus on renal histologic patterns. HIV-positive group - 99 biopsies were suitable for study. The main histologic categories were 'classic HIVAN' (27%) and HIV immune complex kidney disease ('HIVICK') (21%). The subepithelial immune deposits in 'HIVICK' induced a newly described 'ball-in-cup' basement membrane reaction. Other glomerulonephritides included membranous, post-infectious disease, mesangial hyperplasia, and immunoglobulin A nephropathy. Overlapping clinical presentations prevented pre-biopsy histologic predictions. HIV-negative group - There were no examples of collapsing focal segmental glomerulosclerosis or nonspecific immune complex disease, but increased numbers of minimal change and membranoproliferative disease. 'Classic HIVAN' accounted for less than a third of the nephropathies occurring in HIV-positive Black South Africans. 'HIVICK' is another important cause of chronic kidney disease in this group. Future research is needed into the earlier detection and treatment of these diseases, which have a high mortality in our context.

A Survey of the Management, Control, and Complications of Diabetes Mellitus in Patients Attending a Diabetes Clinic in Blantyre, Malawi, an Area of High HIV Prevalence

“…Another study in which renal biopsies were performed on HIV-positive patients in South Africa found that 2 of 99 patients had evidence of diabetic nephropathy. 34 Both patients were known to be diabetic, but the authors do not report the prevalence of diabetes in their cohort. 34 Although nephropathy is common in both conditions, it is not known whether HIV infection and diabetes have a synergistic effect in the kidney to cause or accelerate progression of renal disease.…”

“…34 Both patients were known to be diabetic, but the authors do not report the prevalence of diabetes in their cohort. 34 Although nephropathy is common in both conditions, it is not known whether HIV infection and diabetes have a synergistic effect in the kidney to cause or accelerate progression of renal disease. Our data do go some way in supporting this theory, although further investigation is required.…”

Urologic complications of HIV and AIDS

“…Histologic findings include focal segmental glomerulosclerosis, usually with tubulointerstitial nephritis. 9 In a single study from South Africa, 10 renal biopsies in HIV-positive black patients showed that the main histologic categories of kidney disease were classic HIVAN (27%) and HIV-related 'immune complex kidney disease' (21%). Other glomerulonephritides included membranous disease, postinfectious disease, mesangial hyperplasia, and immunoglobulin A nephropathy.…”

Genetic Susceptibility, HIV Infection, and the Kidney

“…This finding is consistent with known genetic diversity of the African population and clearly demonstrates interpopulation heterogeneity in regard to susceptibility to HIVAN. This notion is further illustrated in a study of South Africans, in which collapsing glomerulopathy was the most common histopathologic entity observed among HIV-positive individuals (59,60). However, a significant proportion of HIV-positive black South Africans also presented with an unconventional form of immune complex glomerulopathy, suggesting interindividual variation in susceptibility to classic HIVAN among this population (59).…”

“…This notion is further illustrated in a study of South Africans, in which collapsing glomerulopathy was the most common histopathologic entity observed among HIV-positive individuals (59,60). However, a significant proportion of HIV-positive black South Africans also presented with an unconventional form of immune complex glomerulopathy, suggesting interindividual variation in susceptibility to classic HIVAN among this population (59). Interindividual variation, racial differences, and familial clustering of kidney disease strongly suggest the existence of HIVAN-specific genetic susceptibility factors that are unmasked in the setting of HIV infection.…”