HIV-associated nephropathy: clinical presentation, pathology, and epidemiology in the era of antiretroviral therapy.

Journal Article (Journal Article;Review)

The classic kidney disease of human immunodeficiency virus (HIV) infection, HIV-associated nephropathy, is characterized by progressive acute renal failure, often accompanied by proteinuria and ultrasound findings of enlarged, echogenic kidneys. Definitive diagnosis requires kidney biopsy, which shows collapsing focal segmental glomerulosclerosis with associated microcystic tubular dilatation and interstitial inflammation. Podocyte proliferation is a hallmark of HIV-associated nephropathy, although this classic pathology is observed less frequently in antiretroviral-treated patients. The pathogenesis of HIV-associated nephropathy involves direct HIV infection of renal epithelial cells, and the widespread introduction of combination antiretroviral therapy has had a significant impact on the natural history and epidemiology of this unique disease. These observations have established antiretroviral therapy as the cornerstone of treatment for HIV-associated nephropathy in the absence of prospective clinical trials. Adjunctive therapy for HIV-associated nephropathy includes angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, as well as corticosteroids in selected patients with significant interstitial inflammation or rapid progression.

Full Text

Duke Authors

Cited Authors

  • Wyatt, CM; Klotman, PE; D'Agati, VD

Published Date

  • November 2008

Published In

Volume / Issue

  • 28 / 6

Start / End Page

  • 513 - 522

PubMed ID

  • 19013322

Pubmed Central ID

  • PMC2656916

International Standard Serial Number (ISSN)

  • 0270-9295

Digital Object Identifier (DOI)

  • 10.1016/j.semnephrol.2008.08.005


  • eng

Conference Location

  • United States