HIV Nephropathy

Aka: HIV Nephropathy, AIDS associated Nephropathy, HIVAN

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II. Epidemiology

  1. HIV Nephropathy is associated with increased mortality in HIV

III. Pathophysiology

  1. HIV associated glomerulopathy
  2. HIV infects renal epithelial cells
    1. Promotes HIV gene expression (esp. Nef, Vpr) within renal cells
    2. Cellular organelle dysfunction (mitochondria, endolysosomes)
    3. Stress kinase activation

IV. Risk Factors

  1. Black race
  2. Older age
  3. Advanced Immunosuppression
    1. CD4 Count <200 cells/mm3
    2. HIV Viral Loads high
  4. Hepatitis C Virus coninfection
  5. Injection drug use
  6. APOL1-Mediated Kidney Disease (AMKD)

V. Findings

  1. Edema
  2. Hypertension (may be present)

VI. Labs

  1. Urinalysis and Urine Protein Quantification
    1. Proteinuria (nephrotic range)
    2. Nephrotic Syndrome
    3. Hematuria (may be present)
  2. Renal Function Tests (Serum Creatinine, Blood Urea Nitrogen)
    1. Azotemia (Rapidly progressive, irreversible)
  3. Renal Biopsy
    1. Focal Segmental Glomerulosclerosis (collapsing)

VII. Imaging

  1. Renal Ultrasound
    1. Increased Kidney size and echogenicity

VIII. Course

  1. End Stage Renal Disease develops in 4-16 weeks

IX. Differential Diagnosis

  1. See Nephrotic Syndrome
  2. Heroin-associated nephropathy
    1. In contrast, HIV Nephropathy lacks Severe Hypertension, Peripheral Edema, Anasarca

X. Diagnosis

  1. Renal Ultrasound
    1. Kidneys are usually enlarged in HIV Nephropathy
  2. Renal Biopsy confirms diagnosis

XI. Management

  1. No known specific treatment
  2. Antiretroviral therapy for HIV
  3. ACE Inhibitor or Angiotensin Receptor Blocker
    1. See ACE Inhibitors and ARBs in Diabetic Nephropathy
    2. Indicated for persistent Proteinuria
  4. Manage comorbidities
    1. See Prevention of Kidney Disease Progression
    2. See Diabetic Nephropathy
    3. Avoid Nephrotoxic Drug
    4. Manage Renal Osteodystrophy
  5. End Stage Renal Disease
    1. Hemodialysis
    2. Renal Transplant (risk of recurrent HIVAN)

XII. Prevention

  1. Screen for renal disease at time of HIV diagnosis and then every 6 months (more frequently if high risk)
  2. Avoid Nephrotoxic Drugs
    1. See Renal Manifestations of HIV
    2. See Nephrotoxic Drugs

XIII. References

  1. Baloor (2018) Exam Preparatory Manual for Undergraduates Medicine, Jaypee Brothers, India, p. 240
  2. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]

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Related Studies

Ontology: AIDS-Associated Nephropathy (C0078911)

Definition (MSHFRE) Symptomatologie rénale retrouvée chez les malades infectés par le virus de l'immunodéficience humaine (VIH). On retrouve un syndrome néphrotique avec une protéinurie sévère. La lésion dominante est glomérulaire avec un aspect de hyalinose focale et segmentaire, souvent associée à des lésions tubulaires et interstitielles et à des gros reins. Le syndrome est différent de celui des néphropathies associées à la consommation d'héroïne ainsi que des autres formes de maladie rénale des patients VIH positifs.
Definition (NCI) Renal syndrome in human immunodeficiency virus-infected patients characterized by nephrotic syndrome, severe proteinuria, focal and segmental glomerulosclerosis with distinctive tubular and interstitial changes, enlarged kidneys, and peculiar tubuloreticular structures. The syndrome is distinct from heroin-associated nephropathy as well as other forms of kidney disease seen in HIV-infected patients.
Definition (MSH) Renal syndrome in human immunodeficiency virus-infected patients characterized by nephrotic syndrome, severe proteinuria, focal and segmental glomerulosclerosis with distinctive tubular and interstitial changes, enlarged kidneys, and peculiar tubuloreticular structures. The syndrome is distinct from heroin-associated nephropathy as well as other forms of kidney disease seen in HIV-infected patients.
Concepts Disease or Syndrome (T047)
MSH D016263
SnomedCT 236406007
English AIDS Associated Nephropathy, AIDS Nephropathies, AIDS Nephropathy, AIDS-Associated Nephropathies, AIDS-Associated Nephropathy, HIV Associated Nephropathy, HIV Related Nephropathy, HIV-Associated Nephropathies, HIV-Associated Nephropathy, HIV-Related Nephropathies, HIV-Related Nephropathy, Human Immunodeficiency Virus-Associated Nephropathy, Nephropathies, AIDS, Nephropathies, AIDS-Associated, Nephropathies, HIV-Associated, Nephropathies, HIV-Related, Nephropathy, AIDS, Nephropathy, AIDS-Associated, Nephropathy, HIV-Associated, Nephropathy, HIV-Related, AIDS Associated Nephropathies, HIV Associated Nephropathies, HIV Related Nephropathies, Nephropathies, AIDS Associated, Nephropathies, HIV Associated, Nephropathies, HIV Related, Nephropathy, AIDS Associated, Nephropathy, HIV Associated, Nephropathy, HIV Related, AIDS-related nephropathy, AIDS-Related Nephropathy, HIV RELAT NEPHROPATHIES, HIV RELAT NEPHROPATHY, NEPHROPATHY HIV RELAT, NEPHROPATHY AIDS ASSOC, NEPHROPATHY HIV ASSOC, AIDS ASSOC NEPHROPATHIES, HIVAN, HUMAN IMMUNODEFIC VIRUS ASSOC NEPHROPATHY, NEPHROPATHIES AIDS ASSOC, NEPHROPATHIES HIV RELAT, AIDS ASSOC NEPHROPATHY, HIV ASSOC NEPHROPATHIES, NEPHROPATHIES HIV ASSOC, HIV-associated nephropathy, HIV-associated nephropathy (diagnosis), Hum immdef vir-rel nephropath, AIDS-Associated Nephropathy [Disease/Finding], HIV associated nephropathy, hiv-associated nephropathy, nephropathy aids-associated, Human Immunodeficiency Virus Associated Nephropathy, AIDS - Acquired immune deficiency synd-related nephropathy, Acquired immune deficiency syndrome-related nephropathy, Human immunodeficiency virus-related nephropathy, Acquired immune deficiency syndrome-related nephropathy (disorder)
German AIDS-assoziierte Nephropathien, HIV-assoziierte Nephropathien, Mit HIV zusammenhaengende Nekropathie, AIDS-assoziierte Nephropathie, HIV-assoziierte Nephropathie, Nephropathie, HIV-assoziierte, Human-Immunodeficiency-Virus-assoziierte Nephropathie
French HIVAN (HIV-Associated Nephropathy), Néphropathie associée au SIDA, Néphropathie associée au VIH
Swedish AIDS-associerad nefropati
Czech nefropatie doprovázející AIDS, Nefropatie související s HIV
Finnish AIDS-nefropatia
Russian IMMUNODEFITSITA CHELOVEKA VIRUS-SVIAZANNAIA NEFROPATIIA, VICH-SVIAZANNAIA NEFROPATIIA, SPID-ASSOTSIIROVANNAIA NEFROPATIIA, ВИЧ-СВЯЗАННАЯ НЕФРОПАТИЯ, ИММУНОДЕФИЦИТА ЧЕЛОВЕКА ВИРУС-СВЯЗАННАЯ НЕФРОПАТИЯ, СПИД-АССОЦИИРОВАННАЯ НЕФРОПАТИЯ
Japanese AIDS関連腎症, ＨＩＶ関連腎症, HIVｶﾝﾚﾝｼﾞﾝｼｮｳ, 腎症-AIDS関連, HIV-関連腎症, エイズ関連腎症, ヒト免疫不全ウイルス関連腎症, HIV関連腎症
Italian Nefropatia HIV-associata, Nefropatia HIV-correlata, Nefropatie HIV-associate, Nefropatie HIV-correlate, Nefropatie associate ad AIDS, Neuropatia associata a HIV, Nefropatia associata ad AIDS
Spanish Nefropatía asociada al VIH, nefropatía relacionada con el síndrome de inmunodeficiencia adquirida (trastorno), nefropatía relacionada con el síndrome de inmunodeficiencia adquirida, nefropatía relacionada con el virus de la inmunodeficiencia humana, Nefropatía Asociada al Vírus de la Inmunodeficiencia Humana, Nefropatía Asociada a SIDA, Nefropatía Asociada a VIH
Portuguese Nefropatia associada ao HIV, Nefropatia Associada a AIDS, Nefropatia Associada ao HIV, Nefropatia Associada ao Vírus da Imunodeficiência Humana
Polish Nefropatia związana z HIV, Nefropatia związana z AIDS
Hungarian HIV-hez kapcsolódó nephropathia
Norwegian Hiv-assosiert nefropati, Aids-assosiert nefropati, Humant immunsviktvirus-assosiert nefropati
Dutch Aids-geassocieerde nefropathie, HIV-geassocieerde nefropathie, Nefropathie, aids-geassocieerde
Derived from the NIH UMLS (Unified Medical Language System)

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