[Human immunodeficiency virus and acute renal insufficiency]

Area of Science:

• Nephrology
• Infectious Diseases
• Virology

Context:

• Acute renal insufficiency (ARI) is a significant complication in patients with human immunoinsufficiency virus (HIV) infection.
• A study at Tenon hospital analyzed 90 adult HIV-infected patients admitted for ARI between 1988 and 1996.
• Pathological diagnoses were obtained in 60 patients, while others were excluded due to contraindications for renal biopsy.

Purpose:

• To describe the spectrum of renal diseases causing acute renal insufficiency in HIV-infected patients.
• To identify the specific causes and characteristics of kidney injury in this population.
• To explore potential associations between renal pathology, co-infections, and treatment modalities.

Summary:

• HIV-associated nephropathy (HIVAN) was diagnosed in 14 patients, characterized by focal and segmental glomerulosclerosis, podocyte hyperplasia, and tubular distension. Partial renal recovery was observed in 10 of these patients.
• Hemolytic-uremic syndrome (HUS) was a major cause (32 cases), frequently associated with active cytomegalovirus (CMV) infection. Increased plasma tissue-type plasminogen activator activity was noted in HIV-associated HUS.
• Other causes included intratubular drug deposition (Adiazine, Foscavir, Indinavir), monoclonal light chain deposition, lupus-like glomerulonephritis, and acute tubular necrosis (potentially revealing HIV infection).

Impact:

• The heterogeneity of renal diseases highlights the evolving nature of HIV-related kidney complications, influenced by infections and antiretroviral therapies.
• Understanding these diverse pathologies is crucial for timely diagnosis and management of kidney dysfunction in HIV patients.
• Anticipates the emergence of new HIV-associated renal diseases with long-term use of antiproteases.