Some patients with HIV disease will develop a nephropathy associated with nephrotic level proteinuria, termed HIV-associated nephropathy (HIVAN). The condition usually progresses over several months to renal failure if untreated.


Clinical features:

(1) HIV-positive, often with history of an AIDS-defining condition

(2) most commonly seen in Afro-Americans

(3) nephrotic syndrome with severe proteinuria

(4) focal segmental glomerulosclerosis

(5) rapid progression to renal insufficiency over several weeks or months

(6) exclusion of other causes of nephropathy


Usual histologic findings seen on renal biopsy:

(1) focal sclerosing glomerulosclerosis with collapse of the glomerular tuft

(2) pseudocrescents formed from retracted glomeruli with hypertrophy and vacuolization of visceral epithelial cells

(3) microcystic dilatation in the tubules (tubular ectasia)

(4) diffuse tubulointerstitial changes


Occasional patients will not show the glomerulosclerosis but may show:

(1) mesangial proliferation

(2) membranous nephropathy

(3) other forms of glomerulonephritis


Differential diagnosis:

(1) heroin nephropathy

(2) Indinavir nephropathy

(3) autoimmune nephropathy

(4) diabetic nephropathy



(1) prednisone may provide short-term improvement

(2) ACE inhibitors may improve renal function

(3) HAART therapy improves survival


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