HIV-associated nephropathy

What it is in this material

In the renal material HIV shows up as a nephrotic syndrome, and the pattern it is tied to is focal segmental glomerulosclerosis. HIV is one of the infections listed under the secondary causes of nephrotic syndrome, beside hepatitis B and hepatitis C.

On the list that divides the causes of nephrotic syndrome into primary and secondary:

• Primary: minimal change disease, focal segmental glomerulosclerosis, membranous glomerulopathy or nephropathy, membranoproliferative glomerulonephritis, and IgA nephropathy
• Secondary: systemic disease, that is diabetes, SLE and amyloidosis; infections, that is HIV, hepatitis B and hepatitis C; pre-eclampsia; and drugs

And on the table that divides glomerular disease down the middle, focal segmental glomerulosclerosis sits on the nephrotic side, the side of proteinuria and oedema, with minimal change disease, membranous GN, amyloidosis and diabetic nephropathy; the nephritic side, of haematuria and hypertension, holds rapidly progressive GN, diffuse proliferative GN, IgA nephropathy, membranoproliferative GN, Alport syndrome and post-streptococcal GN.

How it presents

Nephrotic syndrome by its diagnostic criteria is heavy proteinuria of more than 3.5 g/24hrs with hypoalbuminemia. The patient may report frothy urine and edema, and there may or may not be hyperlipidemia with an elevated LDL cholesterol, and lipiduria with fatty casts and oval fat bodies on microscopy.

The clinical clues for this pattern specifically are nephrotic syndrome, hematuria and HTN, a steroid-resistant course, and progressive renal failure, in a patient who is an adult, especially African American, HIV+ or obese.