The spectrum of kidney disease in patients with AIDS in the era of antiretroviral therapy

Kidney Int. 2009 Feb;75(4):428-34. doi: 10.1038/ki.2008.604. Epub 2008 Dec 3.

Abstract

With prolonged survival and aging of the HIV-infected population in the era of antiretroviral therapy, biopsy series have found a broad spectrum of HIV-related and co-morbid kidney disease in these patients. Our study describes the variety of renal pathology found in a prospective cohort of antiretroviral-experienced patients (the Manhattan HIV Brain Bank) who had consented to postmortem organ donation. Nearly one-third of 89 kidney tissue donors had chronic kidney disease, and evidence of some renal pathology was found in 75. The most common diagnoses were arterionephrosclerosis, HIV-associated nephropathy and glomerulonephritis. Other diagnoses included pyelonephritis, interstitial nephritis, diabetic nephropathy, fungal infection and amyloidosis. Excluding 2 instances of acute tubular necrosis, slightly over one-third of the cases would have been predicted using current diagnostic criteria for chronic kidney disease. Based on semi-quantitative analysis of stored specimens, pre-mortem microalbuminuria testing could have identified an additional 12 cases. Future studies are needed to evaluate the cost-effectiveness of more sensitive methods for defining chronic kidney disease, in order to identify HIV-infected patients with early kidney disease who may benefit from antiretroviral therapy and other interventions known to delay disease progression and prevent complications.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Associated Nephropathy
  • Acquired Immunodeficiency Syndrome / complications*
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Cohort Studies
  • Female
  • Glomerulonephritis
  • Humans
  • Kidney Diseases / diagnosis*
  • Male
  • Middle Aged
  • Nephrosclerosis
  • Prospective Studies
  • Tissue Donors

Substances

  • Anti-HIV Agents