Diagnostic sonography of HIV-associated nephropathy: new observations and clinical correlation.

Abstract

OBJECTIVE. HIV-associatednephropathyis an important causeof morbidity that is characterized clinically by uremia and proteinuria and histologically by focal segmental glomerulosclerosis. In the largestseriesyet analyzed to our knowledge,we describenew sonographic findings and record the prevalence of other findings. We review the sonographic findings in a large group of HIV-infected patients. MATERIALS AND METHODS. Seventy-sixconsecutiveHIV-infected patientsunderwent renal sonography. Abnormalities seen on sonography were recorded.RESULTS. Of 152 kidneysimaged,sonographyshowedthat 30 kidneys(20%) were en larged. Abnormal echogenicity was present in 136 kidneys (89%). Eighty-one kidneys (53%) were globular; 58 (38%) had decreasedcorticomedullary definition; 74 (49%) had decreased renal sinus fat; and 66 (43%) had heterogeneous parenchyma, some with echogenic striations. CONCLUSION.Our datarevealseveralsonographic abnormalitiesthat havenot previ ously been described: decreased corticomedullary definition, decreased renal sinus fat, paren chymal heterogeneity, and globular renal configuration. These new findings were found mainly in patients with advanced HIV infection. R enal involvement in patients with l-HV infection is an important cause of morbidity. Rao et al.[1] first describedan HIV-associatednephropathy characterized by rapid deteriorationof renal function and proteinuria. These researchers re ported 100% mortality within 6 months after the onset of uremia. Subsequent studies have described the sonographic findings of enlarged kidneysandincreased renalechogenicity asso ciatedwith thehistopathologic findingof focal segmental glomerulosclerosis 12â€"4]. To further distinguish, characterize, andshowtheprogres sion of renal sonographic findings associated with HIV infection, we reviewed the findings in a large group of HIV-infected patients. Materials and MethodsOur studygroupconsistedof 76 consecutiveHIV infected patients who underwent renal sonography and whose studies were available for retrospective re view. All patients were referred for imaging because of the onset of elevated creatinine levels. HIV infec tion was determined by positive serology findings.Twentypatientswere HIV-infectedand 56 had AIDS on the basis ofcnteria defined by the Centers for Dis who had sex with men, 37 were IV drug users, five were men who both had sex with men and were IV drug users. one received multiple blood transfusions, and three had no known risk factors. Sixty-seven pa tients were men and nine were women. The patients were 23â€"71 years old (mean. 37 years).Patients were examined with real-time sono graphic systems includingthe 128and XP scanners (Acuson.MountainView,CA) and the VST Masters (Diasonics, Milpitas, CA). Scanning was performed with 3-to 5-MHz transducers. Multiple sections were obtained to evaluate renal length and renal cor tex echogenicityas part of our standardprotocolfor renalsonography.Each patient's sonograms were evaluated retro spectively by a physician experienced in interpreting sonography.Kidneys ...

TB co-infection with HIV/AIDS: a unique radiological presentation at Lacor hospital -a postconflict northern Uganda.

“…Fibro-cavitations were similarly noted in other previous studies in Africa and particularly Uganda (Nimfa, 2002;Sharma, 2007;Di Fiori, 1998;Chaisson, 1987;Eriki, 1991). Therefore, significant burden of HIV-related tuberculosis was probably due to reactivation of the latent infection and progression of chronic disease as a result of immunodeficiency (table 2).…”

Sonography as a Predictor of Human Immunodeficiency Virus-Associated Nephropathy

“…In addition, a highly echogenic cortex has been shown to be the most common abnormality in patients with parenchymal renal diseases and patients with HIV-related renal disorders. 3,8 Nonetheless, earlier studies have shown no correlation between the nature and severity of the glomerular lesion on renal biopsy and the sonographic findings. [9][10][11][12] Paivansalo et al 8 observed that, although an echogenic cortex was slightly more frequent in tubulointerstitial diseases than in the glomerular ones, no specific sonographic Insuff obs indicates insufficient observations.…”

“…There is a misconception among uninformed radiologists and nephrologists that enlarged kidneys are a consistent finding in HIV-positive patients, but that has been dismissed by several prior studies. 2,3 This perception is based on published case reports and nephrology textbook citations. 15 In a study by Di Fiori et al 3 in which sonographic findings in a large group of HIVinfected patients were reviewed, only 20% of 152 kidneys imaged were enlarged.…”

“…1 Distinct renal sonographic findings have been reported in this population, including enlarged kidneys and increased cortical echogenicity. [2][3][4][5] The correlation of these sonographic findings and the pathologic diagnosis of human immunodeficiency virus-associated nephropathy (HIVAN) has not been well studied. In addition, it is not known whether the sonographic characteristics in HIVpositive individuals with HIVAN differ from those with other histologic lesions.…”

HIV associated nephropathy: a treatable condition

“…The characteristic findings are of a black patient with relatively late stage HIV disease presenting with proteinuria (>1 g/24 hours), rising serum creatinine, and enlarged echogenic kidneys on ultrasound. 26 Other causes of renal failure (table 1) should be excluded (table 2) 34 and a renal biopsy will be necessary in cases not typical of HIVAN (table 2) or in patients failing to respond to therapy which includes HAART.…”