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HIV Nephropathy - Causes, Clinical Manifestations, Diagnosis, and Treatment

Published on Sep 22, 2022   -  5 min read

Abstract

HIV Nephropathy is a kidney disease that develops in association with infection by the human immunodeficiency virus (HIV). Read the following article to know more.

Contents

Introduction:

HIV Nephropathy occurs in patients infected by a virus called HIV, which eventually leads to acute renal failure. These viruses infect the renal tissues and replicate within them, causing damage to the renal tissues. It can be defined as collapsing glomerulopathy as it affects the glomerular capillaries, causing obstruction and altering kidney function. The renal epithelium is found to be the reservoir of HIV infection, which harbors the transcriptionally active viruses.

What Is the History Behind HIV Nephropathy?

The first case of HIV Nephropathy was reported in 1984 in Newyork city. Within a few years of the first reported case, it was identified as one of the major complications of acquired immunodeficiency syndrome (AIDS), affecting the majority of the population. In 1999 it was found to be the third leading cause of end-stage renal disease.

What Is HIV Nephropathy?

It is a disease condition affecting the kidneys in patients infected by HIV. It is also known as HIV-associated nephropathy and has evolved as one of the important causes of chronic kidney disease and renal failure.

What Is HIV?

The human Immunodeficiency virus is an RNA virus that belongs to the retrovirus family. It is a sexually transmitted infection that causes a serious illness in humans called AIDS, which suppresses the immune system paving the way for the development of life-threatening opportunistic infections, carcinomas, and other serious disorders.

What Is the Epidemiology of HIV Nephropathy?

The incidence of HIV Nephropathy was high in the 1990s because of the lack of knowledge and poor treatment facilities. Studies report that it is predominantly seen among African descendants, but the recent statistics show that the prevalence of the disease has decreased comparatively due to the implementation of combined antiretroviral therapies, which limits the disease process.

What Is the Etiology of HIV Nephropathy?

As stated earlier, It is exclusively seen in patients infected with HIV. The possible factors involved in the rapid progression of the disease involves

What Is the Pathogenesis of HIV Nephropathy?

The exact mechanism of how the HIV cells affect the kidney is still unclear because the main receptors required for the virus to enter T-cells are absent in the kidney. The lymphocytes such as CD 209 antigen and lymphocyte antigen 75 are found to be directly involved in the infection of renal tubular epithelial cells. The HIV proteins such as Vpr and tat that circulate in the plasma and lipids have access to the specialized epithelial cells that cover the surface of the glomerular capillaries called podocytes, thereby gaining entry into the renal tissues and causing infection.

What Are the Clinical Manifestations of HIV Nephropathy?

It is a rapidly progressive renal disease that may lead to end-stage renal disease in no time once it gains entry into the nephrons. The accompanying signs and symptoms include:

How Is HIV Nephropathy Diagnosed?

The vital methods involved in the diagnosis of HIV Nephropathy involve:

1. History and Clinical Examination

Collecting proper history from the patient regarding the preexisting disease and the appropriate clinical examination is the first and foremost thing to be considered.

2. Laboratory Findings

This includes:

3. Light Microscopic Findings

Histopathological findings reveal:

4. Immunofluorescence Findings

The immunofluorescence findings reveal the segmental deposition of IgM and C3 in the collapsed glomeruli. Visceral epithelial cells show positive staining for IgG, IgA, and Albumin.

What Are All the Differential Diagnosis of HIV Nephropathy?

The conditions to be considered as a differential diagnosis for HIV Nephropathy may include

How to Manage HIV Nephropathy?

The main aim of managing this condition is to prevent the disease from progressing to end-stage renal disease.

What Is the Prognosis of HIV Nephropathy?

HIV Nephropathy was reported to be an aggressive disease with a poor prognosis till the implementation of antiretroviral therapy in the treatment of this disease. After the introduction of antiretroviral therapy, the prognosis of the disease has improved considerably. But the prognosis of HIV Nephropathy is bad when compared to nephropathy due to other causes.

What Are the Complications of HIV Nephropathy?

The most common complications of HIV Nephropathy are:

Other rare complications include:

Conclusion

HIV Nephropathy is a rapidly progressive disease that needs to be addressed earlier. Prompt diagnosis and treatment of the underlying condition are essential to prevent the development of renal failure. Regular follow-up and frequent kidney function tests are necessary for susceptible individuals.

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Last reviewed at:
22 Sep 2022  -  5 min read

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