HIV-associated nephropathy
Human disease
HIV-associated nephropathy (HIVAN) refers to kidney disease developing in association with infection by human immunodeficiency virus, the virus that causes AIDS. The most common, or "classical", type of HIV-associated nephropathy is a collapsing focal segmental glomerulosclerosis (FSGS), though other forms of kidney disease may also occur. Regardless of the underlying histology, kidney disease in HIV-positive patients is associated with an increased risk of death.
Cause
HIVAN may be caused by direct infection of the kidney cells by HIV, with resulting kidney damage through the viral gene products. It could also be caused by the release of cytokines during HIV infection. Usually occurs only in advanced HIV disease and approximately 80% of patients with HIVAN have a CD4 count of less than 200. HIVAN presents with nephrotic syndrome and progressive kidney failure. Despite being a cause of chronic kidney failure, kidney sizes are usually normal or large.
Pathology
Abnormalities involve all components of the nephron. Typical findings are that of collapsing capillary loops, areas of scarring called focal segmental glomerulosclerosis (FSGS), microcystic tubular dilatation that is highly echogenic, and prominent podocytes. The characteristic feature of collapsing glomerulopathy is collapse of glomerular tuft and proliferation and hyperplasia of glomerular visceral epithelial cells.
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