Kidney In HIV

HIV associated FSGS:
  • High frequency of collapsing variant (collapse and sclerosis of entire glomerular tuft)
  • Striking focal cystic dilation of tubules
  • Large no. of tubuloreticular inclusions in endothelial cells (not present in idiopathic FSGS)
  • Poor prognosis
  • Aggressive form is characterized by HIV infection along with microcystic tubular dilatation and interstitial fibrosis.
  • Viral genome has been detected in glomerular and tubular cells.
  • HIV infection is associated with focal segmental glomerulosclerosis, acute diffuse proliferative glomerulonephritis, and mesangioproliferative glomerulonephritis, including IgA nephropathy, MPGN, and membranous glomerulopathy.
  • The 'classic and most common' HIV-associated glomerulopathy is an 'aggressive form of focal segmental glomerulosclerosis', an entity that is termed HIV-associated nephropathy (HIVAN).
  • Focal segmental GN variant of Glomerulonephritis is associated with AIDS
  • This disease may be the first manifestation of infection in otherwise asymptomatic patients. HIV is more common in blacks than in other ethnic groups and is more frequent in intravenous drug abusers with HIV infection than in homosexuals.
  • The disease has been described in all high-risk groups, however, including infants of HIV-positive mothers.
  • Renal biopsy typically reveals visceral epithelial cell swelling, collapse of the glomerular capillary tuft, severe tubulointerstitial inflammation, and microcystic dilatation of renal tubules. Electron microscopy characteristically reveals severe visceral epithelial cell injury and tubuloreticular inclusions in glomerular endothelial cells, tubular cells and infiltrating leukocytes. This constellation of findings has been termed collapsing glomerulopathy, but it should be emphasized that a similar picture can be seen in the absence of HIV infection. 
  • The presence of tubuloreticular inclusions and the aggressive clinical course distinguish HIV from idiopathic focal segmental glomerulosclerosis.
  • The typical clinical correlates of HIV are severe nephrotic syndrome and rapid progression to ESRD, occurring in weeks to months.
Morphological changes in FSGS
  • Sclerosis of some glomeruli with involvement of only a portion of capillary tuft.
  • Collapse of GBM.
  • Increase in matrix.
  • Segmental insudation of plasma proteins along the capillary wall (Hyalinosis).
  • Lipid droplets and foam cells.
  • Diffuse effacement of foot processes characteristic of minimal change disease, but in addition, there is focal detachment of the epithelial cells with denudation of the underlying GBM.
  • IgM and C3 deposits in sclerosed area and in the mesangium.
  • Collapsing alomerulorlathy
  • It is a morphological variant of FSGS.
  • Characterized by collapse and sclerosis of the entire glomerular tuft in addition to the usual FSGS lesions.
  • A characteristic feature is proliferation and hypertrophy of glomerular visceral epithelial cells (podocytes). o There is prominent tubular injury with formation of microcystes.
  • It is the most characteristic lesion of HIV nephropathy.
  • Epithelial damage is the hallmark of FSGS.
Wegener's Granulomatosis :
  • Necrotizing vasculitis of small arteries and veins together with granuloma formation that can be either intravascular or extravascular.
  • Lung involvement: bilateral nodular cavitary infiltrates, demonstrate necrotizing granulornatous vasculitis.
  • The renal biopsy lesion is that of a pauci-immune necrotizing and crescentic GN.
Minimal Change Disease / (Nil) disease / Lipoid Nephrosis
In association with systemic diseases or drugs major cause are:
  1. HIV infection
  2. Hodgkins disease and other Lymphoproliferative malignancies
  3. Drug induced Interstitial Nephritis
  4. NSAIDS
  5. Rifampicin
  6. Interferon
Exam Question
  • Focal segmental GN variant of Glomerulonephritis is associated with AIDS
  • HIV associated nephropathy is a type of Collapsing glomerulopathy
  • HIV infection is associated with focal segmental glomerulosclerosis, acute diffuse proliferative glomerulonephritis, and mesangioproliferative glomerulonephritis, including IgA nephropathy, MPGN, and membranous glomerulopathy.
  • HIV infection, Hodgkins disease, and other Lymphoproliferative malignancies, Drug induced Interstitial Nephritis( NSAIDS ,Rifampicin, Interferon) are the conditions associated with minimal change disease
  • HIV renal specific nephropathy is Focal Segmental Glomerulosclerosis

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