Observations on a Cohort of HIV-Infected Patients Undergoing Native Renal Biopsy

Berliner, Adam R.; Fine, Derek M.; Lucas, Gregory M.; Rahman, Mostafizur; Racusen, Lorraine C.; Scheel, Paul J.; Atta, Mohamed G.

doi:10.1159/000112851

Cited by 116 publications

(135 citation statements)

References 34 publications

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“…These data are consistent with the previously reported frequencies of IN (11%-20%) and biopsyproven ATN (10%-16.7%) in this population, respectively (4,11,15,(17)(18)(19). Compared with HIV-infected patients with histopathological diagnosis of glomerular disease established between 1995 and 2007 (10), TIN patients were less frequently of black origin (27% versus 63%), had a better virological control (undetectable viral load: 47% versus 28%), and had a higher percentage of received ARV therapy (89.3% versus 73%).…”

Section: Discussionsupporting

confidence: 93%

“…In the mid-1990s, combinational use of antiretroviral (ARV) agents in highly active antiretroviral therapy regimen was associated with a dramatic decrease in the mortality of HIV patients and incidence of HIVAN (8)(9)(10). In the meantime, nephrotoxicity of new ARVs and renal complications of dysimmune disorders, including immune reconstitution inflammatory syndrome (IRIS) and diffuse infiltrative lymphocytosis syndrome (DILS), were reported (4,(11)(12)(13)(14). In a North American series of 262 HIV-infected patients who underwent a kidney biopsy, diagnosis of acute IN was established in 11% of renal biopsies between 1995 and 2008 (15).…”

Section: Introductionmentioning

confidence: 99%

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Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years

Zaidan

Lescure

Brochériou

et al. 2013

Clinical Journal of the American Society of Nephrology

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Summary 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.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years

Zaidan

Lescure

Brochériou

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…In a report of 152 consecutive renal biopsies in patients with HIV infection at our institution, HIVAN was indeed the most common diagnosis, seen in 34.9% of specimens (2). The third most common diagnosis in this series was acute interstitial nephritis (AIN; 7.9%).…”

mentioning

confidence: 64%

Characteristics of Patients with HIV and Biopsy-Proven Acute Interstitial Nephritis

Parkhie¹,

Fine²,

Lucas³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Results: Of 262 biopsies, 29 (11%) patients who had AIN without evidence of HIV-associated nephropathy were identified. The mean age at the time of biopsy was 47.5 years (range 28 to 71 years), 17 (59%) were men, and 23 (79%) were black. The majority (62%) of patients were on antiretroviral therapy, 59% were current or former intravenous drug users, and 62% had hepatitis C co-infection. Drugs were identified as the cause of AIN in the majority (72%) of cases. Nonsteroidal antiinflammatory drugs were most commonly implicated, followed by sulfamethoxazole/trimethoprim. Antiretroviral therapy was identified as the cause in only three cases. None of the patients presented with the classic triad of fever, rash, and pyuria, and only seven (24%) patients presented with <1 g/d proteinuria.Conclusions: In our series, AIN was prevalent (11%) and was often drug induced. AIN should not be excluded from the differential diagnosis on the basis of absence of the classic clinical triad of fever, rash, and pyuria.

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“…Kidney disease in HIV-infected patients encompasses an array of renal pathologies (6). These processes may be directly mediated by HIV, such as in HIV-associated nephropathy (HIVAN); related to HIV coexisting conditions, such as diabetes, hypertension, and intravenous drug use; or associated with drugs toxic to the kidneys.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Risk Factors and Outcomes in HIV Immune Complex Kidney Disease and HIV-Associated Nephropathy

Foy

Estrella²,

Lucas³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives HIV-associated nephropathy (HIVAN) is well described, but the clinical features of a group of renal pathologies characterized by Ig or immune complex depositions referred to as HIV-associated immune complex kidney disease (HIVICK) have not been well established. The objective of this study is to assess risk factors for HIVICK compared with contemporaneous control participants.Design, setting, participants, & measurements A nested case-control study of 751 HIV-infected patients followed from January 1996 to June 2010 was conducted. Groups were compared using the chi-squared test or ranksum analysis. Conditional logistic regression was used to estimate odds ratios (ORs) for HIVICK. Incidences of overall ESRD and with/without combined antiretroviral therapy (cART) exposure were calculated.Results HIVICK patients were predominantly African American (92%). Compared with matched controls, patients with HIVICK were more likely to have HIV RNA .400 copies/ml (OR, 2.5; 95% confidence interval [95% CI], 1.2 to 5.2), diabetes (OR, 2.8; 95% CI, 1.1 to 6.8), and hypertension (OR, 2.3; 95% CI, 1.2 to 4.5). Compared with HIVAN, patients with HIVICK had more antiretroviral therapy exposure, lower HIV viral loads, and higher CD4 and estimated GFR. ESRD was less common in the HIVICK versus the HIVAN group (30% versus 82%; P,0.001), and the use of cART was not associated with ESRD in HIVICK patients (25% versus 26; P=0.39).Conclusions HIVICK was predominantly observed in African-American patients and associated with advanced HIV disease. ESRD incidence is lower in HIVICK patients compared with those with HIVAN. Unlike HIVAN, cART use was not associated with the incidence of ESRD in HIVICK.

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Observations on a Cohort of HIV-Infected Patients Undergoing Native Renal Biopsy

Cited by 116 publications

References 34 publications

Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years

Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years

Characteristics of Patients with HIV and Biopsy-Proven Acute Interstitial Nephritis

Comparison of Risk Factors and Outcomes in HIV Immune Complex Kidney Disease and HIV-Associated Nephropathy

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