HIV-associated nephropathy (HIVAN)

INTRODUCTION

HIV infection has been associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). (See "Overview of kidney disease in HIV-positive patients".)

HIV-associated nephropathy (HIVAN), the classic kidney disease associated with HIV infection, was first described in 1984 as a complication of AIDS [1-3], although HIVAN may also occur in patients with less advanced HIV infection or acute seroconversion [4,5]. Histologically, HIVAN is a collapsing form of focal sclerosing glomerulosclerosis (FSGS) (picture 1), which can be distinguished from idiopathic FSGS by the presence of microcystic tubular dilatation and interstitial inflammation [6].

Issues related to HIVAN will be discussed in this topic. An overview of kidney disease in patients with HIV infection and discussions of electrolyte abnormalities, dialysis, and transplantation in HIV-infected patients are provided elsewhere. (See "Overview of kidney disease in HIV-positive patients" and "Electrolyte disturbances with HIV infection" and "Human immunodeficiency virus and dialysis" and "Solid organ transplantation in HIV-infected individuals".)

PATHOGENESIS

The pathogenesis of HIV-associated nephropathy (HIVAN) is hypothesized to involve several factors:

Infection of kidney epithelial cells by HIV and expression of HIV genes within infected kidney cells

              

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Literature review current through: Aug 2014. | This topic last updated: Oct 17, 2013.
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References
Top
  1. Gardenswartz MH, Lerner CW, Seligson GR, et al. Renal disease in patients with AIDS: a clinicopathologic study. Clin Nephrol 1984; 21:197.
  2. Pardo V, Aldana M, Colton RM, et al. Glomerular lesions in the acquired immunodeficiency syndrome. Ann Intern Med 1984; 101:429.
  3. Rao TK, Filippone EJ, Nicastri AD, et al. Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome. N Engl J Med 1984; 310:669.
  4. Winston JA, Bruggeman LA, Ross MD, et al. Nephropathy and establishment of a renal reservoir of HIV type 1 during primary infection. N Engl J Med 2001; 344:1979.
  5. Levin ML, Palella F, Shah S, et al. Hiv-associated nephropathy occurring before HIV antibody seroconversion. Am J Kidney Dis 2001; 37:E39.
  6. Laurinavicius A, Hurwitz S, Rennke HG. Collapsing glomerulopathy in HIV and non-HIV patients: a clinicopathological and follow-up study. Kidney Int 1999; 56:2203.
  7. Dickie P, Felser J, Eckhaus M, et al. HIV-associated nephropathy in transgenic mice expressing HIV-1 genes. Virology 1991; 185:109.
  8. Kopp JB, Klotman ME, Adler SH, et al. Progressive glomerulosclerosis and enhanced renal accumulation of basement membrane components in mice transgenic for human immunodeficiency virus type 1 genes. Proc Natl Acad Sci U S A 1992; 89:1577.
  9. Bruggeman LA, Dikman S, Meng C, et al. Nephropathy in human immunodeficiency virus-1 transgenic mice is due to renal transgene expression. J Clin Invest 1997; 100:84.
  10. Dickie P, Roberts A, Uwiera R, et al. Focal glomerulosclerosis in proviral and c-fms transgenic mice links Vpr expression to HIV-associated nephropathy. Virology 2004; 322:69.
  11. Kajiyama W, Kopp JB, Marinos NJ, et al. Glomerulosclerosis and viral gene expression in HIV-transgenic mice: role of nef. Kidney Int 2000; 58:1148.
  12. Hanna Z, Kay DG, Rebai N, et al. Nef harbors a major determinant of pathogenicity for an AIDS-like disease induced by HIV-1 in transgenic mice. Cell 1998; 95:163.
  13. Husain M, Gusella GL, Klotman ME, et al. HIV-1 Nef induces proliferation and anchorage-independent growth in podocytes. J Am Soc Nephrol 2002; 13:1806.
  14. Bruggeman LA, Ross MD, Tanji N, et al. Renal epithelium is a previously unrecognized site of HIV-1 infection. J Am Soc Nephrol 2000; 11:2079.
  15. Ross MJ, Bruggeman LA, Wilson PD, Klotman PE. Microcyst formation and HIV-1 gene expression occur in multiple nephron segments in HIV-associated nephropathy. J Am Soc Nephrol 2001; 12:2645.
  16. Kopp JB, Smith MW, Nelson GW, et al. MYH9 is a major-effect risk gene for focal segmental glomerulosclerosis. Nat Genet 2008; 40:1175.
  17. Genovese G, Friedman DJ, Ross MD, et al. Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science 2010; 329:841.
  18. Kopp JB, Nelson GW, Sampath K, et al. APOL1 genetic variants in focal segmental glomerulosclerosis and HIV-associated nephropathy. J Am Soc Nephrol 2011; 22:2129.
  19. Papeta N, Kiryluk K, Patel A, et al. APOL1 variants increase risk for FSGS and HIVAN but not IgA nephropathy. J Am Soc Nephrol 2011; 22:1991.
  20. Estrella MM, Wyatt CM, Pearce CL, et al. Host APOL1 genotype is independently associated with proteinuria in HIV infection. Kidney Int 2013; 84:834.
  21. Atta MG, Estrella MM, Kuperman M, et al. HIV-associated nephropathy patients with and without apolipoprotein L1 gene variants have similar clinical and pathological characteristics. Kidney Int 2012; 82:338.
  22. Ross MD, Bruggeman LA, Hanss B, et al. Podocan, a novel small leucine-rich repeat protein expressed in the sclerotic glomerular lesion of experimental HIV-associated nephropathy. J Biol Chem 2003; 278:33248.
  23. Kaufman L, Hayashi K, Ross MJ, et al. Sidekick-1 is upregulated in glomeruli in HIV-associated nephropathy. J Am Soc Nephrol 2004; 15:1721.
  24. Gharavi AG, Ahmad T, Wong RD, et al. Mapping a locus for susceptibility to HIV-1-associated nephropathy to mouse chromosome 3. Proc Natl Acad Sci U S A 2004; 101:2488.
  25. Abbott KC, Hypolite I, Welch PG, Agodoa LY. Human immunodeficiency virus/acquired immunodeficiency syndrome-associated nephropathy at end-stage renal disease in the United States: patient characteristics and survival in the pre highly active antiretroviral therapy era. J Nephrol 2001; 14:377.
  26. US Renal Data System (USRDS): USRDS 2004 Annual Data Report: Atlas of End-stage Renal Disease in the United States. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, 2004.
  27. Schwartz EJ, Szczech LA, Ross MJ, et al. Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol 2005; 16:2412.
  28. Lucas GM, Eustace JA, Sozio S, et al. Highly active antiretroviral therapy and the incidence of HIV-1-associated nephropathy: a 12-year cohort study. AIDS 2004; 18:541.
  29. Williams DI, Williams DJ, Williams IG, et al. Presentation, pathology, and outcome of HIV associated renal disease in a specialist centre for HIV/AIDS. Sex Transm Infect 1998; 74:179.
  30. Lescure FX, Flateau C, Pacanowski J, et al. HIV-associated kidney glomerular diseases: changes with time and HAART. Nephrol Dial Transplant 2012; 27:2349.
  31. Bigé N, Lanternier F, Viard JP, et al. Presentation of HIV-associated nephropathy and outcome in HAART-treated patients. Nephrol Dial Transplant 2012; 27:1114.
  32. Ramsuran D, Bhimma R, Ramdial PK, et al. The spectrum of HIV-related nephropathy in children. Pediatr Nephrol 2012; 27:821.
  33. D'Agati V, Appel GB. Renal pathology of human immunodeficiency virus infection. Semin Nephrol 1998; 18:406.
  34. Barisoni L, Kriz W, Mundel P, D'Agati V. The dysregulated podocyte phenotype: a novel concept in the pathogenesis of collapsing idiopathic focal segmental glomerulosclerosis and HIV-associated nephropathy. J Am Soc Nephrol 1999; 10:51.
  35. Atta MG, Choi MJ, Longenecker JC, et al. Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy. Am J Med 2005; 118:1288.
  36. KDIGO. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int Suppl 2012; 2:209. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO-GN-Guideline.pdf (Accessed on December 23, 2013).
  37. Yahaya I, Uthman OA, Uthman MM. Interventions for HIV-associated nephropathy. Cochrane Database Syst Rev 2013; 1:CD007183.
  38. Szczech LA, Gupta SK, Habash R, et al. The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. Kidney Int 2004; 66:1145.
  39. Atta MG, Gallant JE, Rahman MH, et al. Antiretroviral therapy in the treatment of HIV-associated nephropathy. Nephrol Dial Transplant 2006; 21:2809.
  40. Cosgrove CJ, Abu-Alfa AK, Perazella MA. Observations on HIV-associated renal disease in the era of highly active antiretroviral therapy. Am J Med Sci 2002; 323:102.
  41. Kirchner JT. Resolution of renal failure after initiation of HAART: 3 cases and a discussion of the literature. AIDS Read 2002; 12:103.
  42. Scheurer D. Rapid reversal of renal failure after initiation of HAART: a case report. AIDS Read 2004; 14:443.
  43. Kimmel PL, Mishkin GJ, Umana WO. Captopril and renal survival in patients with human immunodeficiency virus nephropathy. Am J Kidney Dis 1996; 28:202.
  44. Wei A, Burns GC, Williams BA, et al. Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition. Kidney Int 2003; 64:1462.
  45. Burns GC, Paul SK, Toth IR, Sivak SL. Effect of angiotensin-converting enzyme inhibition in HIV-associated nephropathy. J Am Soc Nephrol 1997; 8:1140.
  46. Eustace JA, Nuermberger E, Choi M, et al. Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids. Kidney Int 2000; 58:1253.
  47. Smith MC, Austen JL, Carey JT, et al. Prednisone improves renal function and proteinuria in human immunodeficiency virus-associated nephropathy. Am J Med 1996; 101:41.
  48. Post FA, Campbell LJ, Hamzah L, et al. Predictors of renal outcome in HIV-associated nephropathy. Clin Infect Dis 2008; 46:1282.