The answer: B. Direct viral infiltration of the kidneys is common with active
HIV disease and reducing viral titer is associated with improvements in proteinuria
and renal function.
The Question
The Question
A 28-year old man who is HIV seropositive has been lost to follow-up for six years. He now has proteinuria (3.5 g/24 hr) and azotemia (serum creatinine of 2.2 mg/dL). His CD4 lymphocyte count is 150/mm3, and plasma viral load is 120,000 RNA copies/mL. Kidney biopsy shows collapsing FSGS, microcystic dilatation of tubules, and an interstitial infiltrate. Highly active antiretroviral therapy (HAART) is initiated. If the HIV infection responds to HAART, which of the following is the most likely outcome?
A. Progression of chronic kidney disease, with rapid development of ESRD in less than six months
B. Improvement of chronic kidney disease, with a reduction in proteinuria and serum creatinine
C. Transition into a membranous glomerulonephropathy
D. No effect on course of renal disease
Explanation
Explanation
HIV-associated nephropathy (HIVAN), formerly known as
AIDS-associated nephropathy, is characterized by the following findings:
- Nephrotic range proteinuria
- Azotemia
- Normal to large kidneys on ultrasound images
- Focal segmental glomerulosclerosis (FSGS) on renal biopsy findings
FSGS is the predominant glomerular lesion in HIVAN,
other reported glomerular lesions in patients with HIV include IgA nephropathy,
cryoglobulinemia, amyloidosis, and a lupuslike immune complex glomerulopathy.
See images published in the NEJM.
