Nephrotic syndrome in adult black South Africans: HIV-associated nephropathy as the main culprit

J Natl Med Assoc. 2010 Dec;102(12):1193-7. doi: 10.1016/s0027-9684(15)30774-4.


Background: Glomerular diseases, accompanied by nephrotic syndrome, contribute significantly to end-stage renal disease (ESRD) worldwide. We sought to show the distribution and frequency of biopsy-proven causes of nephrotic syndrome in native black Africans attending the Groote Schuur Hospital in Cape Town, South Africa.

Methods: We retrospectively reviewed the biopsy data of 294 black South Africans with biopsy-proven cause of nephrotic syndrome in Cape Town over a 10-year period. Nephrotic proteinuria was accepted as urine protein excretion of at least 3.5 g in 24 hours. Glomerular diseases were classified into primary and secondary types. Serum creatinine concentrations were stratified into 3 levels to reflect the degree of renal dysfunction at the time of presentation. The frequency and distribution of disease were recorded according to age and gender.

Results: Young adults (< or = 40 years of age) constituted 74.1% of the study population. Secondary glomerular diseases were more frequent (58.8%) and human immunodeficiency virus-associated nephropathy (HIVAN) was observed as the leading cause of nephrotic syndrome in both males and females (42.8%). Most patients with HIVAN (73.6%) presented for the first time with severe renal impairment and more than half of patients with non-HIVAN glomerular diseases presented with an abnormal serum creatinine. Of the primary glomerular diseases, mesangiocapillary glomerulonephritis was the commonest cause of the nephrotic syndrome (19.0%), while IgA nephropathy was the least common cause (1.7%).

Conclusions: HIVAN is a major cause of nephrotic syndrome in black South Africans and may be responsible for the rising incidence of ESRD in Africa.

MeSH terms

  • AIDS-Associated Nephropathy / complications*
  • AIDS-Associated Nephropathy / epidemiology
  • Adult
  • Biopsy
  • Chi-Square Distribution
  • Creatinine / blood
  • Female
  • Humans
  • Male
  • Nephrotic Syndrome / epidemiology
  • Nephrotic Syndrome / etiology*
  • Retrospective Studies
  • South Africa / epidemiology


  • Creatinine