The Clinical Characteristics and Pathological Patterns of Postinfectious Glomerulonephritis in HIV-Infected Patients

Abstract

BackgroundPostinfectious glomerulonephritis (PIGN), a form of immune complex GN, is not well-defined in HIV-infected patients. This study characterizes PIGN in this patients’ population and determine the impact of histopathological patterns on renal outcome and mortality.MethodsHIV-infected patients with PIGN from September 1998 to July 2013 were identified. Archived slides were reviewed by a blinded renal pathologist, classified into acute, persistent and healed PIGN. Groups were compared using Wilcoxon rank-sum and Fisher’s exact test. Survival analyses were performed to determine association of histopathological pattern with renal outcome and mortality.ResultsSeventy-two HIV-infected predominantly African American males were identified with PIGN. Median (interquartile range) age and creatinine at the time of renal biopsy was 48 years (41, 53) and 2.5 mg/dl (1.5, 4.9) respectively. Only 2 (3%) had acute PIGN, 42 (58%) had persistent PIGN and 28 (39%) had healed PIGN. Three patients (4%) had IgA-dominant PIGN. Only 46% of the patients had confirmed positive cultures with Staphylococcus the most common infectious agent. During a median follow up of 17 months, the pathological pattern had no impact on renal outcome (P = 0.95). Overall mortality was high occurring in 14 patients (19%); patients with healed PIGN had significantly increased mortality (P = 0.05).ConclusionIn HIV-infected patients, Staphylococcus is the most common cause of PIGN. Renal outcome was not influenced by the histopathological pattern but those with healed PIGN had greater mortality which was potentially due to a confounder not accounted for in the study.

HIV-associated Immune Complex Kidney Disease with C3-dominant Deposition Induced by HIV Infection after Treatment of IgA Nephropathy

“…PIGN is characterized by endocapillary proliferative glomerulonephritis on LM and large subepithelial electron-dense deposits or “humps” on EM developing within a few weeks following recovery from infection. A total of 46% of HIV-infected patients with PIGN were confirmed to have a bacterial infection by positive blood culture (18). Complement activation by AP can be seen during infections that trigger the development of PIGN, and some cases of PIGN with persistent hematuria and proteinuria show an underlying abnormality in the regulatory factors of AP (19).…”

HBV-Associated Postinfectious Acute Glomerulonephritis: A Report of 10 Cases

“…Post-infectious glomerulonephritis (PIGN) is an immune-mediated glomerular disease that predominantly occurs in children following infection in the upper respiratory or skin [ 1 , 2 ]. Recently however, increasing prevalence of PIGN has also been found in immunocompromised adults and other older individuals, particularly in conjunction with diabetes and other morbidities [ 3 , 4 ]. While it is difficult to estimate the precise prevalence of PIGN due to underreporting, PIGN remains a problem in the developing world (1) .…”