Renal disease in human immunodeficiency virus - Not just HIV-associated nephropathy

Vali, PS; Ismal, K; Gowrishankar, Swarnalata; Sahay, Manisha

doi:10.4103/0971-4065.97117

Cited by 15 publications

(12 citation statements)

References 9 publications

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“…Furthermore, of the 27 patients diagnosed with HIVAN on renal biopsy in a study in South Africa, only 3 were on ART [ 17 ]. This reaffirms the importance of renal biopsy in accurately diagnosing renal disease, particularly HIVAN [ 12 , 17 , 48 ], so that ART can be initiated early to improve outcomes. Sadly, due to a lack of resources and specialists, access to renal biopsy is limited to urban tertiary hospitals in South Africa.…”

Section: Discussionsupporting

confidence: 53%

“…In the current review, HIVAN was the most common histology seen on renal biopsy [ 15 , 31 ]. Other histologies have been documented in various studies both locally [ 12 , 17 , 22 , 31 ] and overseas [ 48 ]. The third leading cause of end stage renal disease (ESRD) in African Americans aged between 20 and 64 years was found to be HIVAN [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

et al. 2017

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BackgroundIt is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa. South Africa has recently adopted WHO policy, stipulating that all HIV-infected patients have access to antiretroviral treatment (ART) irrespective of CD4 cell count.MethodsWe searched Google Scholar, PubMed, Medline, Cochrane Library, Worldcat.org and EBSCO host databases from July 2015 to December 2015. Eligibility criteria included articles pertaining to renal manifestations of HIV in South Africa from 2004 to 2015 in adult patients (≥ 18 years). We independently reviewed the articles for quality. Thematic content analysis was performed to identify patterns of renal manifestations from the included studies. The risk of bias (e.g. internal validity) in the included studies was evaluated using the mixed methods appraisal tool.ResultsEleven out 21 studies were eligible for data extraction. The prevalence of urine abnormalities on urine dipsticks was high but had poor sensitivity and specificity for detecting renal impairment. Normal renal function occurred in 28.4 to 79% of patients, mild renal impairment occurred in 19 to 57.1% and moderate renal impairment in 2 to 14.4%. Severe renal impairment occurred in 1.3% of patients. Both the Cockcroft-Gault equation (after correcting for bias) and the 4-variable Modification of Diet in Renal Disease equation (without the ethnicity factor for African Americans) have been validated for the estimation of glomerular filtration rate (eGFR) in Black South Africans. HIV-associated nephropathy was the most prevalent histology seen (57.2%). Older age, a lower CD4 count, a low haemoglobin and a detectable viral load were associated with renal impairment. Renal function improved in the first year of commencing ART as evidenced by the regression of proteinuria and the increase in eGFR.ConclusionThe findings of the review have implications to the recently adopted ‘test and treat’ approach to HIV prevention and management.Systematic review registrationPROSPERO CRD42016039270 Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0605-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

et al. 2017

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“…Kidney biopsy series in HIV patients from India, have reported wide variability in prevalence of HIVAN, ranging from 0% to 85% [Table 3]. [89101112133435] These widely variable results emphasize limitations on drawing conclusions from single-center studies with small sample sizes. Therefore, we did a systemic review of literature on kidney biopsy in adult HIV patients from India.…”

Section: Discussionmentioning

confidence: 99%

“…While HIVAN has been reported consistently in Western studies, the prevalence in studies from Asia has been found to low/absent. [78] The available studies from India differ strikingly, with some studies showing presence of HIVAN,[91011] whereas others reporting complete absence of this entity. [81213] With this perspective, the present study was carried out to elucidate the histological spectrum of renal disease in HIV patients from a tertiary care center from India.…”

Section: Introductionmentioning

confidence: 99%

Histological spectrum of renal disease in HIV/AIDS patients with significant proteinuria: An Indian perspective

Verma¹,

Singh²

2019

J Family Med Prim Care

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Background: Chronic kidney disease (CKD) has become epidemic in HIV/AIDS patients across Western and Eastern countries. HIV-associated nephropathy (HIVAN) has been consistently reported in studies from North America, Europe and African countries. However, studies from Asian countries are very sparse and differ strikingly in histological spectrum of renal disease, particularly in presence of HIVAN. Objectives: The study was carried out to in a teaching hospital from India to delineate the histological spectrum of renal disease and detect presence HIVAN in those with significant proteinuria (≥1gm/day). Patients and Methods: Urine analysis was done in 510 consecutive hospitalised HIV/AIDS patients after screening 640 such patients with age >18years. Patients with dipstick proteinuria ≥1+ were subjected to 24-hour urinary protein estimation. Renal biopsy was done in 10 patients with proteinuria ≥1gm/day. Results: Dipstick proteinuria ≥1+ was present in 29% patients. In patients undergoing kidney biopsy, the most frequent glomerular lesion was mesangial proliferative glomerulonephritis (30%) followed by HIVAN (20%). Tubulo-interstitial lesions were seen in 60% of biopsies. Pooled analysis of all the available kidney biopsy series from India revealed prevalence of HIVAN to be 16.5%. Conclusion: Contrary to the popular belief, HIVAN appears to be a common entity in this part of world too. High degree of clinical suspicion is required as diagnosis of HIVAN caries higher morbidity and mortality. Moreover, an early diagnosis and timely management can improve prognosis in such patients.

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“…India faces the threat of an AIDS epidemic; nevertheless risk factors and the racial background of our HIV positive population are different from those in the western countries (1). As studies pertaining to renal diseases in HIV and data on their histopathological lesions from India are limited, (4,5) this study was conducted to document the clinicopathological features of various renal diseases in an HIV-positive patient population in a south Indian tertiary care center.…”

Section: Introductionmentioning

confidence: 99%

Renal disease in human immunodeficiency virus infection; a divergent array

Satish¹,

Nadig²,

Vankalakunti³

et al. 2018

J Nephropathol

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Background: Renal disease is an important cause of morbidity and mortality in populations with HIV infection. Widespread use of combination antiretroviral therapy has altered the spectrum of renal disease. Studies among the HIV affected population in India are few. Objectives: The study was carried out to determine the various histopathological lesions in HIV patients with renal dysfunction, undergoing a renal biopsy, and to establish the clinico-pathological correlation. Patients and Methods: Thirty HIV-positive patients, diagnosed by enzyme-linked immunosorbent assay (ELISA) method according to the National AIDS Control Organization (NACO) guidelines, undergoing a renal biopsy for renal dysfunction were studied. Descriptive statistics were applied. Results: Rather than the classic human immunodeficiency virus associated nephropathy (HIVAN) or a few prototypical lesions, the cases were spread across the entire spectrum of glomerular and tubulointerstitial pathologies described in the HIV population. A higher proportion of diabetic nephropathy, IgA nephropathy and chronic interstitial nephritis were encountered in the present study. Conclusions: In the present scenario of increasing incidence of HIV infection, studying its various manifestations are relevant. As none of the clinical or laboratory variables are found to predict glomerular versus non-glomerular lesions on biopsy, a renal biopsy is indicated in renal dysfunction associated with HIV, to make an accurate diagnosis and for therapy.

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Renal disease in human immunodeficiency virus - Not just HIV-associated nephropathy

Cited by 15 publications

References 9 publications

Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

Histological spectrum of renal disease in HIV/AIDS patients with significant proteinuria: An Indian perspective

Renal disease in human immunodeficiency virus infection; a divergent array

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