Expert column: recent developments and current issues in HIV-related renal disease

Lynda Anne Szczech, MD, MSCE
Medscape HIV/AIDS 7(3), 2001. C 2001 Medscape, Inc.

While many glomerular diseases complicate HIV infection, the majority of clinical and research attention has been directed towards HIV-associated nephropathy (HIVAN), a glomerulopathy demonstrating focal segmental glomerulosclerosis (FSGS) with collapsing features.

Clinically, patients present with nephrotic syndrome and progressive renal insufficiency. Great advances have recently been made in understanding the pathogenesis and defining potential treatment strategies for HIVAN, but little is known about either the pathobiology or possible strategies for treatment of the other glomerular diseases. Cumulatively, as many as one third of HIV-infected patients with renal disease who undergo renal biopsy will have glomerular diseases other than HIVAN.[1] This additional spectrum of renal diseases associated with HIV infection includes membranoproliferative glomerulonephritis, minimal change disease, membranous glomerulopathy, amyloidosis, immune-complex glomerulonephritis, and IgA nephropathy.[2-11] Care must be taken in research and in clinical practice to avoid assumptions about either the homogeneity or heterogeneity of the epidemiology and natural history of these lesions. Given the limited knowledge of the epidemiology and clinical course for lesions other than HIVAN, this update will focus primarily on the recent advances in HIVAN.