Renal Disease in Children with the Acquired Immunodeficiency Syndrome

Abstract

Of 155 children with the acquired immunodeficiency syndrome (AIDS) whom we evaluated during a 6 1/2-year period, 12 were found to have proteinuria. Histologic studies of tissue from these 12 patients revealed a wide spectrum of renal disease: focal glomerulosclerosis in 5, mesangial hyperplasia in 5, segmental necrotizing glomerulonephritis in 1, and minimal change disease in 1. In addition, 6 had tubulointerstitial infiltrates, and 10 had glomerular dense deposits. All 10 renal specimens studied by electron microscopy contained endothelial tubuloreticular inclusions. The mean age (+/- SD) of the five patients with focal glomerulosclerosis when this condition was identified was 27 +/- 19 months. All five had severe renal failure within a year and died of other causes during the following year. The mean age of the five patients with mesangial hyperplasia was 38 +/- 31 months. Although none of them went on to have renal failure, four died within 8 +/- 7 months. Ten of the 12 patients with proteinuria died during the study period. Of the two surviving, one had mesangial hyperplasia and the other had minimal change disease. We conclude that children who acquire human immunodeficiency virus (HIV) infection during the perinatal period may have renal disease, most often focal glomerulosclerosis, as is the case in adults, or mesangial hyperplasia. Although 5 of the 12 children we studied had renal failure during the study period, none died of it. Further studies are needed to determine the correlations between clinical and pathological features and the pathophysiology of AIDS nephropathy in children.

The Kidney as a Reservoir for HIV-1 after Renal Transplantation

“…These inclusions consist of structures located within the dilated cisternae of the endoplasmic reticulum and are frequently, but not specifically, observed during HIVAN. 11 Finally, these patients had a rapid decline in renal function ( Figure 2A) and 40% (n=2) reached ESRD in the first 3 years of transplantation.…”

Iron-Related Proteins

“…H IV-infected children can develop proteinuria secondary to several renal diseases, including immune complex glomerulopathies, thrombotic microangiopathies (TMA), and HIV-associated nephropathy (HIVAN) (1)(2)(3)(4)(5). In general, these renal diseases show a progressive clinical onset, and can have a significant clinical impact in the quality of life of HIV-infected children.…”

“…Childhood HIVAN is typically seen in African American patients and is defined by the presence of heavy proteinuria, with mesangial hyperplasia or focal segmental glomerulosclerosis (FSGS) in association with microcystic tubular changes, leading to renal enlargement and rapid progression of the renal disease (1)(2)(3)(4)(5). HIV-infected children can also develop an atypical form of the Hemolytic Uremic Syndrome (HUS) characterized by a progressive clinical onset, lack of preceding diarrhea, preserved urine output with severe proteinuria, and rapid progression to end-stage renal disease or death due to infectious or bleeding complications (3,4,9).…”

Rhabdomyolysis as the first manifestation of human immunodeficiency virus infection

“…The virus has been shown to cause nephropathy in infected infants of HIVinfected mothers [3]. In animal studies nephropathy was reproduced in transgenic mice and rats infected with the virus [4,5]. This has also been shown in simian models of retroviral infection [6].…”