Tubulointerstitial nephropathies in HIV-infected patients over the past 15 years: a clinico-pathological study

Clin J Am Soc Nephrol. 2013 Jun;8(6):930-8. doi: 10.2215/CJN.10051012. Epub 2013 Feb 21.


Background and objectives: The therapy and outcome of HIV infection have dramatically changed over the last 15 years, resulting in a change in renal complications. This study analyzed the characteristics of HIV-infected patients and biopsy-proven tubulointerstitial nephropathies to define disease patterns and therapeutic implications.

Design, setting, participants, & measurements: A clinico-pathologic retrospective study of 59 consecutive renal biopsies showing predominant tubular and/or interstitial lesions in HIV-infected patients referred to the nephrology department between 1995 and 2011 was performed. HIV-associated nephropathy and vascular diseases were excluded from the study.

Results: Tubulointerstitial nephropathies accounted for 26.6% of 222 native renal biopsies performed in HIV-infected patients. Two pathologic groups were analyzed, tubulopathy and interstitial nephritis, which represented 49% and 51% of tubulointerstitial nephropathies, respectively. Most patients presented with AKI (76.3%) and high-grade proteinuria (57.7%). Drug-related nephrotoxicity was the leading cause (52.5%). Alternative etiologies included infections (15.2%), dysimmune disorders (8.5%), malignancies (3.4%), and chronic (10.2%) and acute (10.2%) tubulointerstitial nephropathies of undetermined origin. Tubulopathy was strongly associated with antiretroviral drug toxicity (75.9%) and mostly caused by tenofovir (55.2%), which was associated with proximal tubular dysfunction (87.5%), overt Fanconi's syndrome (37.5%), and nephrogenic diabetes insipidus (12.5%). Interstitial nephritis was associated with a broader spectrum of pathologic lesions and etiologies.

Conclusions: In this series, tubulointerstitial nephropathies accounted for 26.6% of renal diseases in HIV-infected patients. Considering the therapeutic implications of diagnoses of drug toxicity, infection, and dysimmune syndromes, this study underscores the importance of monitoring renal parameters in HIV-infected patients and points to the relevance of kidney biopsy to allow an accurate diagnosis.

MeSH terms

  • Acute Kidney Injury / etiology
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-HIV Agents / adverse effects*
  • Biopsy
  • Female
  • France
  • HIV Infections / drug therapy*
  • Humans
  • Kidney Tubules / drug effects*
  • Kidney Tubules / immunology
  • Kidney Tubules / pathology
  • Male
  • Middle Aged
  • Neoplasms / complications
  • Nephritis, Interstitial / chemically induced
  • Nephritis, Interstitial / etiology*
  • Nephritis, Interstitial / immunology
  • Nephritis, Interstitial / pathology
  • Proteinuria / etiology
  • Retrospective Studies
  • Risk Factors
  • Shock, Septic / etiology
  • Young Adult


  • Anti-HIV Agents