Hiv-associated nephropathy B22

Most common form of chronic renal failure in patients with HIV1 infection (see below Retroviridae), observed mainly in patients of color for reasons unknown to date (genetic variation in the APOL1 locus on chromosome 22 - Papeta N et al. 2011).

Among African Americans in the USA, the prevalence of renal failure in HIV-infected persons is between 3.5 and 12%. Reports from Nigeria show that 5-60% of the AIDS patients examined are affected by renal failure.

Aetiopathogenetically, HIV-1 induced damage and destruction of podocytes (productive replication of the virus in the podocytes) plays an essential role in HIV-1 associated nephropathy (HIVAN) (Khatua AK et al. 2010).

The clinical symptoms correspond to those of a nephrotic syndrome (proteinuria >3g/d) and are highly variable. Sonographically there is an increased echogenicity and a slight enlargement of the renal parenchyma. With a significantly reduced glomerular filtration rate (eGFR), there are also reduced kidney sizes. If left untreated, a rapidly progressive renal insufficiency occurs.

Special form of focal segmental glomerulosclerosis with glomerular capillary collapse of varying severity (collapsing glomerulopathy). Furthermore, there is a varying degree of proliferation of the mesangial matrix, degenerative, microcystic changes in the tubules and interstitial oedema with inflammatory infiltrates and fibrosis.

Clinic, serology, sonography, kidney biopsy. There are no typical surrogate markers of HIVAN. Differential diagnostically examined values for ANA, ds-DNA, ANCAs, anti-GBM antibodies, cryoglobulins as well as antistreptolysin O antibodies are mostly negative.

Consistent antiretroviral therapy (HAART - Lucas GM et al. 2004). ACE inhibitors can have a beneficial effect. The efficiency of corticosteroids has not yet been sufficiently investigated. In most cases dialysis or transplantation is required (Waheed S et al. 2015). Antiretroviral therapy must be adapted to the type of nephropathy with regard to dose adjustment and interactions.

Untreated, HIVAN leads to rapid progression and terminal renal failure within 1-4 months (Rao TK et al. 1984).

In HIV patients, proteinuria and associated nephropathy are associated with a significantly worse prognosis.

HIV-associated nephropathy is the most common HIV-associated kidney disease. Other HIV-associated kidney diseases are HIV-associated thrombotic microangiopathy (HIV-TMA), immune complex mediated kidney disease (HIVICK). Furthermore, the kidney of HIV patients can also be damaged by the side effects of antiretroviral therapy (drug-induced interstitial nephritis caused by indinavir and ritonavir, rhabdomyolysis caused by statins. Increasingly, IVAN is characterized by increased life expectancy of patients and by the occurrence of comorbidities such as diabetes mellitus, lipid metabolism disorders, hypertension, and nicotine abuse.