HIV associated nephropathy overview: Difference between revisions
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== Natural History, Complications and Prognosis == | == Natural History, Complications and Prognosis == | ||
HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome.<ref name="pmid18588500">{{cite journal| author=Atta MG, Lucas GM, Fine DM| title=HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management. | journal=Expert Rev Anti Infect Ther | year= 2008 | volume= 6 | issue= 3 | pages= 365-71 | pmid=18588500 | doi=10.1586/14787210.6.3.365 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18588500 }}</ref> | |||
== Diagnosis == | == Diagnosis == | ||
Revision as of 14:28, 29 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
HIV-Associated Nephropathy (HIVAN) is a type of collapsing FSGS. Serious renal complication of advanced HIV infection and AIDS leading to chronic and eventually end stage renal failure(ESRF). HIVAN is caused by direct infection of the renal cells with the HIV-1 virus and leads to renal damage through the viral gene products. It could also be caused by changes in the release of cytokines during HIV infection.
Usually occurs only in advanced disease and approximately 80% of patients with HIVAN have a CD4 count of less than 200. HIVAN presents with nephrotic syndrome and progressive renal failure. Despite being a cause of chronic renal failure kidney sizes are usually normal or large.
Overview
Historical Perspective
- AIDS was first reported in 1981.[1][2]
- The first reported cases of HIV-associated nephropathy (HIVAN) were described in 1984.[3]
Pathophysiology
Causes
Differentiating HIV associated nephropathy from other Diseases
HIV-associated nephropathy must be differentiated form other diseases that cause focal segmental glomerulonephritis, high grade proteinuria, and elevated serum creatinine levels.
Epidemiology and Demographics
HIV-associated nephropathy (HIVAN) is mostly seen in male patients and of African decent. The prevalence of HIVAN in the population of patients with African descent has been reported to be 3% to 12%.[4]
Risk Factors
The risk factors that attribute to HIV-associated nephropathy are similar to those seen with HIV. Positive predicators for HIV-associated nephropathy include: Apolipoproetin-1 (APOL1) gene, high viral load, low CD-4 count, proteinuria (nephrotic range), and higher level of renal echogenicity on ultrasound.[5]
Screening
Screening for kidney disease is recommended in high risk populations in all patients with seropositive HIV-1 (upon detection).[6]
Natural History, Complications and Prognosis
HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome.[7]
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
KUB X-ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ Gottlieb MS, Schroff R, Schanker HM, Weisman JD, Fan PT, Wolf RA; et al. (1981). "Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency". N Engl J Med. 305 (24): 1425–31. doi:10.1056/NEJM198112103052401. PMID 6272109.
- ↑ Centers for Disease Control (CDC) (1982). "A cluster of Kaposi's sarcoma and Pneumocystis carinii pneumonia among homosexual male residents of Los Angeles and Orange Counties, California". MMWR Morb Mortal Wkly Rep. 31 (23): 305–7. PMID 6811844.
- ↑ Rao TK, Filippone EJ, Nicastri AD, Landesman SH, Frank E, Chen CK; et al. (1984). "Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome". N Engl J Med. 310 (11): 669–73. doi:10.1056/NEJM198403153101101. PMID 6700641.
- ↑ Menez S, Hanouneh M, McMahon BA, Fine DM, Atta MG (2018). "Pharmacotherapy and treatment options for HIV-associated nephropathy". Expert Opin Pharmacother. 19 (1): 39–48. doi:10.1080/14656566.2017.1416099. PMC 6381591. PMID 29224373.
- ↑ Waheed S, Atta MG (2014). "Predictors of HIV-associated nephropathy". Expert Rev Anti Infect Ther. 12 (5): 555–63. doi:10.1586/14787210.2014.901170. PMID 24655211.
- ↑ Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA; et al. (2018). "HIV-associated nephropathy: links, risks and management". HIV AIDS (Auckl). 10: 73–81. doi:10.2147/HIV.S141978. PMC 5975615. PMID 29872351.
- ↑ Atta MG, Lucas GM, Fine DM (2008). "HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management". Expert Rev Anti Infect Ther. 6 (3): 365–71. doi:10.1586/14787210.6.3.365. PMID 18588500.