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. 2001 Apr;77(2):97–100. doi: 10.1136/sti.77.2.97

HIV associated nephropathy: a treatable condition

M Brook 1, R Miller 1
PMCID: PMC1744263  PMID: 11287685

Abstract

Objectives: To describe current knowledge on the aetiology, pathology, diagnosis, and treatment of HIV associated nephropathy.

Methods: A Medline search was performed using the key words "HIV," "nephropathy," "renal," and "kidney." A further search was performed for each of the currently licensed antiretroviral agents linked to key words "renal" or "kidney" and also using the MeSH heading "pharmacokinetics."

Results: HIV associated nephropathy is a common complication of HIV in black African and Afro-Caribbean patients and presents with progressive renal failure and heavy proteinuria. As other causes of renal failure are likely to fall in incidence among patients successfully treated with highly active antiretroviral therapy (HAART), HIV associated nephropathy will become increasingly prominent as a cause of renal impairment in HIV infected patients. Recent evidence suggests that HIV associated nephropathy will respond to HAART with a dramatic improvement in renal function.

Conclusion: HIV associated nephropathy is a treatable condition. This condition should be actively sought in HIV infected patients if they are to receive the benefits of therapy.

Key Words: HIV; nephropathy; HAART

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barisoni L., Kriz W., Mundel P., D'Agati V. The dysregulated podocyte phenotype: a novel concept in the pathogenesis of collapsing idiopathic focal segmental glomerulosclerosis and HIV-associated nephropathy. J Am Soc Nephrol. 1999 Jan;10(1):51–61. doi: 10.1681/ASN.V10151. [DOI] [PubMed] [Google Scholar]
  2. Barry M., Mulcahy F., Merry C., Gibbons S., Back D. Pharmacokinetics and potential interactions amongst antiretroviral agents used to treat patients with HIV infection. Clin Pharmacokinet. 1999 Apr;36(4):289–304. doi: 10.2165/00003088-199936040-00004. [DOI] [PubMed] [Google Scholar]
  3. Boubaker K., Sudre P., Bally F., Vogel G., Meuwly J. Y., Glauser M. P., Telenti A. Changes in renal function associated with indinavir. AIDS. 1998 Dec 24;12(18):F249–F254. doi: 10.1097/00002030-199818000-00003. [DOI] [PubMed] [Google Scholar]
  4. Burns G. C., Paul S. K., Toth I. R., Sivak S. L. Effect of angiotensin-converting enzyme inhibition in HIV-associated nephropathy. J Am Soc Nephrol. 1997 Jul;8(7):1140–1146. doi: 10.1681/ASN.V871140. [DOI] [PubMed] [Google Scholar]
  5. Chang B. G., Markowitz G. S., Seshan S. V., Seigle R. L., D'Agati V. D. Renal manifestations of concurrent systemic lupus erythematosus and HIV infection. Am J Kidney Dis. 1999 Mar;33(3):441–449. doi: 10.1016/s0272-6386(99)70180-0. [DOI] [PubMed] [Google Scholar]
  6. Cheng J. T., Anderson H. L., Jr, Markowitz G. S., Appel G. B., Pogue V. A., D'Agati V. D. Hepatitis C virus-associated glomerular disease in patients with human immunodeficiency virus coinfection. J Am Soc Nephrol. 1999 Jul;10(7):1566–1574. doi: 10.1681/ASN.V1071566. [DOI] [PubMed] [Google Scholar]
  7. D'Agati V., Appel G. B. Renal pathology of human immunodeficiency virus infection. Semin Nephrol. 1998 Jul;18(4):406–421. [PubMed] [Google Scholar]
  8. Dave M. B., Shabih K., Blum S. Maintenance hemodialysis in patients with HIV-associated nephropathy. Clin Nephrol. 1998 Dec;50(6):367–374. [PubMed] [Google Scholar]
  9. Dellow E. L., Unwin R. J., Miller R. F. Presentation, diagnosis, and management of renal failure in patients with HIV infection. AIDS Patient Care STDS. 2000 Feb;14(2):71–77. doi: 10.1089/108729100317993. [DOI] [PubMed] [Google Scholar]
  10. Di Fiori J. L., Rodrigue D., Kaptein E. M., Ralls P. W. Diagnostic sonography of HIV-associated nephropathy: new observations and clinical correlation. AJR Am J Roentgenol. 1998 Sep;171(3):713–716. doi: 10.2214/ajr.171.3.9725302. [DOI] [PubMed] [Google Scholar]
  11. Erickson D. A., Mather G., Trager W. F., Levy R. H., Keirns J. J. Characterization of the in vitro biotransformation of the HIV-1 reverse transcriptase inhibitor nevirapine by human hepatic cytochromes P-450. Drug Metab Dispos. 1999 Dec;27(12):1488–1495. [PubMed] [Google Scholar]
  12. Freedman B. I., Soucie J. M., Stone S. M., Pegram S. Familial clustering of end-stage renal disease in blacks with HIV-associated nephropathy. Am J Kidney Dis. 1999 Aug;34(2):254–258. doi: 10.1016/s0272-6386(99)70352-5. [DOI] [PubMed] [Google Scholar]
  13. Gupta S. B., Gilbert R. L., Brady A. R., Livingstone S. J., Evans B. G. CD4 cell counts in adults with newly diagnosed HIV infection: results of surveillance in England and Wales, 1990-1998. CD4 Surveillance Scheme Advisory Group. AIDS. 2000 May 5;14(7):853–861. doi: 10.1097/00002030-200005050-00012. [DOI] [PubMed] [Google Scholar]
  14. Gurtman A., Borrego F., Klotman M. E. Management of antiretroviral therapy. Semin Nephrol. 1998 Jul;18(4):459–480. [PubMed] [Google Scholar]
  15. Jayasekara D., Aweeka F. T., Rodriguez R., Kalayjian R. C., Humphreys M. H., Gambertoglio J. G. Antiviral therapy for HIV patients with renal insufficiency. J Acquir Immune Defic Syndr. 1999 Aug 15;21(5):384–395. [PubMed] [Google Scholar]
  16. Kapasi A., Bhat P., Singhal P. C. Tubular cell and HIV-1 gp120 interaction products promote migration of monocytes. Inflammation. 1998 Apr;22(2):137–144. doi: 10.1023/a:1022331905200. [DOI] [PubMed] [Google Scholar]
  17. Kimmel P. L., Bosch J. P., Vassalotti J. A. Treatment of human immunodeficiency virus (HIV)-associated nephropathy. Semin Nephrol. 1998 Jul;18(4):446–458. [PubMed] [Google Scholar]
  18. Kimmel P. L., Mishkin G. J., Umana W. O. Captopril and renal survival in patients with human immunodeficiency virus nephropathy. Am J Kidney Dis. 1996 Aug;28(2):202–208. doi: 10.1016/s0272-6386(96)90302-9. [DOI] [PubMed] [Google Scholar]
  19. Klotman P. E. HIV-associated nephropathy. Kidney Int. 1999 Sep;56(3):1161–1176. doi: 10.1046/j.1523-1755.1999.00748.x. [DOI] [PubMed] [Google Scholar]
  20. Lanjewar D. N., Ansari M. A., Shetty C. R., Maheshwari M. B., Jain P. Renal lesions associated with AIDS--an autopsy study. Indian J Pathol Microbiol. 1999 Jan;42(1):63–68. [PubMed] [Google Scholar]
  21. Laradi A., Mallet A., Beaufils H., Allouache M., Martinez F. HIV-associated nephropathy: outcome and prognosis factors. Groupe d' Etudes Néphrologiques d'Ile de France. J Am Soc Nephrol. 1998 Dec;9(12):2327–2335. doi: 10.1681/ASN.V9122327. [DOI] [PubMed] [Google Scholar]
  22. Law M. G., Li Y., McDonald A. M., Cooper D. A., Kaldor J. M. Estimating the population impact in Australia of improved antiretroviral treatment for HIV infection. AIDS. 2000 Jan 28;14(2):197–201. doi: 10.1097/00002030-200001280-00016. [DOI] [PubMed] [Google Scholar]
  23. Madiwale C., Venkataseshan V. S. Renal lesions in AIDS: a biopsy and autopsy study. Indian J Pathol Microbiol. 1999 Jan;42(1):45–54. [PubMed] [Google Scholar]
  24. Mattana J., Siegal F. P., Schwarzwald E., Molho L., Sankaran R. T., Gooneratne R., Ahuja T. S., Singhal P. C. AIDS-associated membranous nephropathy with advanced renal failure: response to prednisone. Am J Kidney Dis. 1997 Jul;30(1):116–119. doi: 10.1016/s0272-6386(97)90573-4. [DOI] [PubMed] [Google Scholar]
  25. Mokrzycki M. H., Oo T. N., Patel K., Chang C. J. Human immunodeficiency virus-associated nephropathy in the Bronx: low prevalence in a predominantly Hispanic population. Am J Nephrol. 1998;18(6):508–512. doi: 10.1159/000013396. [DOI] [PubMed] [Google Scholar]
  26. O'Donnell M. P., Chao C. C., Gekker G., Modi K. S., Kasiske B. L., Keane W. F. Renal cell cytokine production stimulates HIV-1 expression in chronically HIV-1-infected monocytes. Kidney Int. 1998 Mar;53(3):593–597. doi: 10.1046/j.1523-1755.1998.00789.x. [DOI] [PubMed] [Google Scholar]
  27. Palella F. J., Jr, Delaney K. M., Moorman A. C., Loveless M. O., Fuhrer J., Satten G. A., Aschman D. J., Holmberg S. D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853–860. doi: 10.1056/NEJM199803263381301. [DOI] [PubMed] [Google Scholar]
  28. Peraldi M. N., Maslo C., Akposso K., Mougenot B., Rondeau E., Sraer J. D. Acute renal failure in the course of HIV infection: a single-institution retrospective study of ninety-two patients and sixty renal biopsies. Nephrol Dial Transplant. 1999 Jun;14(6):1578–1585. doi: 10.1093/ndt/14.6.1578. [DOI] [PubMed] [Google Scholar]
  29. Poignet J. L., Desassis J. F., Chanton N., Litchinko M. B., Zins B., Kolko A., Patte R., Sobel A. Prévalence de l'infection à VIH chez les patients dialysés: résultats d'une enquête multicentrique nationale. Nephrologie. 1999;20(3):159–163. [PubMed] [Google Scholar]
  30. Praditpornsilpa K., Napathorn S., Yenrudi S., Wankrairot P., Tungsaga K., Sitprija V. Renal pathology and HIV infection in Thailand. Am J Kidney Dis. 1999 Feb;33(2):282–286. doi: 10.1016/s0272-6386(99)70301-x. [DOI] [PubMed] [Google Scholar]
  31. Rao T. K. Acute renal failure syndromes in human immunodeficiency virus infection. Semin Nephrol. 1998 Jul;18(4):378–395. [PubMed] [Google Scholar]
  32. Rao T. K., Friedman E. A. Outcome of severe acute renal failure in patients with acquired immunodeficiency syndrome. Am J Kidney Dis. 1995 Mar;25(3):390–398. doi: 10.1016/0272-6386(95)90099-3. [DOI] [PubMed] [Google Scholar]
  33. Ray P. E., Liu X. H., Henry D., Dye L., 3rd, Xu L., Orenstein J. M., Schuztbank T. E. Infection of human primary renal epithelial cells with HIV-1 from children with HIV-associated nephropathy. Kidney Int. 1998 May;53(5):1217–1229. doi: 10.1046/j.1523-1755.1998.00900.x. [DOI] [PubMed] [Google Scholar]
  34. Ray P. E., Rakusan T., Loechelt B. J., Selby D. M., Liu X. H., Chandra R. S. Human immunodeficiency virus (HIV)-associated nephropathy in children from the Washington, D.C. area: 12 years' experience. Semin Nephrol. 1998 Jul;18(4):396–405. [PubMed] [Google Scholar]
  35. Riska P., Lamson M., MacGregor T., Sabo J., Hattox S., Pav J., Keirns J. Disposition and biotransformation of the antiretroviral drug nevirapine in humans. Drug Metab Dispos. 1999 Aug;27(8):895–901. [PubMed] [Google Scholar]
  36. Schwartz E. J., Klotman P. E. Pathogenesis of human immunodeficiency virus (HIV)-associated nephropathy. Semin Nephrol. 1998 Jul;18(4):436–445. [PubMed] [Google Scholar]
  37. Singh A., Tejani C., Tejani A. One-center experience with cyclosporine in refractory nephrotic syndrome in children. Pediatr Nephrol. 1999 Jan;13(1):26–32. doi: 10.1007/s004670050557. [DOI] [PubMed] [Google Scholar]
  38. Singhal P. C., Sagar S., Reddy K., Sharma P., Ranjan R., Franki N. HIV-1 gp120 envelope protein and morphine-tubular cell interaction products modulate kidney fibroblast proliferation. J Investig Med. 1998 Jun;46(5):243–248. [PubMed] [Google Scholar]
  39. Singhal P. C., Sharma P., Loona R., Gibbons N., Franki N., Klotman P. E. Enhanced proliferation, apoptosis, and matrix accumulation by mesangial cells derived from HIV-1 transgenic mice. J Investig Med. 1998 Aug;46(6):297–302. [PubMed] [Google Scholar]
  40. Sraer J. D., Peraldie M. N. Virus de l'immunodéficience humaine et insuffisance rénale aiguë. Bull Acad Natl Med. 1997 Dec;181(9):1763–1779. [PubMed] [Google Scholar]
  41. Viani R. M., Dankner W. M., Muelenaer P. A., Spector S. A. Resolution of HIV-associated nephrotic syndrome with highly active antiretroviral therapy delivered by gastrostomy tube. Pediatrics. 1999 Dec;104(6):1394–1396. doi: 10.1542/peds.104.6.1394. [DOI] [PubMed] [Google Scholar]
  42. Wali R. K., Drachenberg C. I., Papadimitriou J. C., Keay S., Ramos E. HIV-1-associated nephropathy and response to highly-active antiretroviral therapy. Lancet. 1998 Sep 5;352(9130):783–784. doi: 10.1016/S0140-6736(98)24037-2. [DOI] [PubMed] [Google Scholar]
  43. Watterson M. K., Detwiler R. K., Bolin P., Jr Clinical response to prolonged corticosteroids in a patient with human immunodeficiency virus-associated nephropathy. Am J Kidney Dis. 1997 Apr;29(4):624–626. doi: 10.1016/s0272-6386(97)90348-6. [DOI] [PubMed] [Google Scholar]
  44. Williams D. I., Williams D. J., Williams I. G., Unwin R. J., Griffiths M. H., Miller R. F. Presentation, pathology, and outcome of HIV associated renal disease in a specialist centre for HIV/AIDS. Sex Transm Infect. 1998 Jun;74(3):179–184. doi: 10.1136/sti.74.3.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Winston J. A., Burns G. C., Klotman P. E. The human immunodeficiency virus (HIV) epidemic and HIV-associated nephropathy. Semin Nephrol. 1998 Jul;18(4):373–377. [PubMed] [Google Scholar]
  46. Winston J. A., Klotman M. E., Klotman P. E. HIV-associated nephropathy is a late, not early, manifestation of HIV-1 infection. Kidney Int. 1999 Mar;55(3):1036–1040. doi: 10.1046/j.1523-1755.1999.0550031036.x. [DOI] [PubMed] [Google Scholar]
  47. Yamamoto T., Noble N. A., Miller D. E., Gold L. I., Hishida A., Nagase M., Cohen A. H., Border W. A. Increased levels of transforming growth factor-beta in HIV-associated nephropathy. Kidney Int. 1999 Feb;55(2):579–592. doi: 10.1046/j.1523-1755.1999.00296.x. [DOI] [PubMed] [Google Scholar]

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