Pathology of HIV-associated nephropathy: A detailed morphologic and comparative study

Abstract

Clinical and pathologic findings in the kidneys of 30 consecutive acquired immunodeficiency syndrome (AIDS) autopsies and in 34 consecutive renal biopsies performed on HIV infected patients at our institution between 1983 and 1987 were studied. To determine if the lesions of HIV-associated nephropathy have morphologic specificity, a subgroup of 13 biopsies with a diagnosis of HIV-associated nephropathy (HIVN) were compared to 13 biopsies each of heroin-associated nephropathy (HAN) and of idiopathic focal segmental glomerulosclerosis (IFSGS) matched for patient age, proteinuria and serum creatinine. A diagnosis of HIVN was made in 1 of 30 (3.3%) AIDS autopsies and 26 of 34 (76.5%) renal biopsies. When compared to HAN and IFSGS, HIVN had more globally "collapsed" glomeruli (P less than 0.001), less glomerular hyalinosis (P less than 0.02), more severe visceral epithelial cell swelling (P less than 0.05), more numerous visceral epithelial cell droplets (P less than 0.002), more prevalent and severe tubular microcystic dilatation (P less than 0.02), and tubular cell degenerative changes (P less than 0.001). Focal glomerular electron-dense deposits were present in 14 of 26 cases. Tubuloreticular inclusions were extremely numerous in glomerular and interstitial capillary endothelial cells as well as in interstitial leukocytes (P less than 0.001). Granular degeneration of nuclear chromatin was present in 10 of 26 cases. Nuclear bodies were more numerous in tubular and interstitial cells of HIVN (P less than 0.01), particularly type 3 (P less than 0.001). Reversal of tissue T4/T8 ratio was observed. We conclude that while no single morphologic feature of HIVN is specific, the combination of clinical and pathologic findings is quite distinctive and permits a presumptive diagnosis of HIVN in otherwise asymptomatic carriers.

Effect of Antiretroviral Drug (arved) on the Kidney in Albino Rat

“…HIVAN usually affects black patients and is known to be a leading cause of end-stage renal disease (ESRD) in this population in North America and in Europe. The marked racial predisposition of HIV-associated nephropathy (HIVAN) to blacks has been previously reported (D' Agati et al, 1998) recent studies have confirmed this association. Analysis of data from United States Renal Data System revealed that HIVAN is more strongly associated with black race than any other cause of failure with the exception of sickle cell disease.…”

Comparison of Risk Factors and Outcomes in HIV Immune Complex Kidney Disease and HIV-Associated Nephropathy

“…Cases were defined as patients with either HIVAN or HIVICK. We defined HIVAN as glomerular segmental or global collapse plus podocyte hypertrophy (25). We defined HIVICK as pathologic findings consistent with "lupus-like" GN, membranous nephropathy, membranoproliferative GN, IgA nephropathy, PIGN, cryoglobulinemia, and immune complex renal disease not otherwise specified (12,13,18,19,26).…”

Tracing the Origin of Glomerular Extracapillary Lesions from Parietal Epithelial Cells

“…2 Collapsing glomerulopathy (CG) is characterized by massive proteinuria and rapid progressive renal insufficiency and histologically by segmental to global collapse of the capillary tuft and pronounced epithelial cell hyperplasia. 3 This pattern has been described in HIV-associated nephropathy, 4 parvovirus B19 infection, 5 and pamidronate toxicity 6 and also as an idiopathic form. 3 The pathomechanism of the development of cellular lesions remains to be established, and in both CrGN and CG the origin of the hyperplastic cells within cellular lesions has been a matter of debate.…”