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Renal disease in children with the acquired immunodeficiency syndrome
J Strauss1, C Abitbol, G Zilleruelo
1Department of Pediatrics, University of Miami School of Medicine, FL 33101.
Insights
Children with acquired immunodeficiency syndrome (AIDS) can develop kidney disease, including focal glomerulosclerosis and mesangial hyperplasia. Proteinuria is a key indicator of this AIDS nephropathy in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pathology
Background:
- Acquired immunodeficiency syndrome (AIDS) can affect multiple organ systems.
- Renal manifestations of human immunodeficiency virus (HIV) infection, known as AIDS nephropathy, are increasingly recognized in children.
Purpose of the Study:
- To investigate the spectrum of renal diseases in children with AIDS.
- To characterize the histological findings and clinical outcomes of pediatric patients with proteinuria and HIV infection.
Main Methods:
- Retrospective analysis of 155 children with AIDS over 6.5 years.
- Histological examination of renal biopsies from 12 children with proteinuria.
- Electron microscopy to identify glomerular changes and tubulointerstitial infiltrates.
Main Results:
- Focal glomerulosclerosis (5/12) and mesangial hyperplasia (5/12) were the most common renal pathologies.
- Tubulointerstitial infiltrates (6/12) and glomerular dense deposits (10/12) were also observed.
- Ten of the 12 children with proteinuria died during the study period; none died from renal failure.
Conclusions:
- Children with perinatally acquired HIV infection can develop AIDS nephropathy, with focal glomerulosclerosis and mesangial hyperplasia being common.
- Further research is needed to understand the clinical-pathological correlations and pathophysiology of pediatric AIDS nephropathy.
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.