Nephropathy

Abstract HIV-associated nephropathy is typically characterized by heavy proteinuria (with nephrotic syndrome), enlarged kidneys, and rapid progression to end-stage renal disease. Because this disorder often develops before the onset of AIDS, most experts prefer the term HIV-associated nephropathy instead of AIDS-associated nephropathy. For unknown reasons, HIV-associated nephropathy has a striking predilection for African-Americans: approximately 85 percent of patients with HIV-associated nephropathy are African-American. The mean age is 33 years, with a male to female ratio of 10:1. Approximately 50 percent of patients with HIV-associated nephropathy have injection-drug use as their risk factor for HIV acquisition. Most reported cases have involved patients living in New York City, Miami, or Los Angeles, with few cases reported from the San Francisco area. These differences in the geographic distribution of HIV-associated nephropathy remain unexplained. Although initial studies suggested that histologic changes solely consisted of focal and segmental glomerulosclerosis, subsequent reports indicate that HIV-associated nephropathy can produce a diverse array of histologic lesions, including global glomerulosclerosis, mesangial hyperplasia, tubular necrosis, microcystic tubular dilatation with casts, and interstitial inflammation. Nevertheless, focal and segmental glomerulosclerosis remains the most distinctive and common histologic lesion. Although heroin-associated nephropathy and HIV-associated nephropathy share some histopathologic findings, these lesions can usually be distinguished from one another.