HIV associated nephropathy

HIV associated nephropathy

WikiDoc Resources for HIV associated nephropathy
Articles
Most recent articles on HIV associated nephropathy Most cited articles on HIV associated nephropathy Review articles on HIV associated nephropathy Articles on HIV associated nephropathy in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on HIV associated nephropathy Images of HIV associated nephropathy Photos of HIV associated nephropathy Podcasts & MP3s on HIV associated nephropathy Videos on HIV associated nephropathy
Evidence Based Medicine
Cochrane Collaboration on HIV associated nephropathy Bandolier on HIV associated nephropathy TRIP on HIV associated nephropathy
Clinical Trials
Ongoing Trials on HIV associated nephropathy at Clinical Trials.gov Trial results on HIV associated nephropathy Clinical Trials on HIV associated nephropathy at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on HIV associated nephropathy NICE Guidance on HIV associated nephropathy NHS PRODIGY Guidance FDA on HIV associated nephropathy CDC on HIV associated nephropathy
Books
Books on HIV associated nephropathy
News
HIV associated nephropathy in the news Be alerted to news on HIV associated nephropathy News trends on HIV associated nephropathy
Commentary
Blogs on HIV associated nephropathy
Definitions
Definitions of HIV associated nephropathy
Patient Resources / Community
Patient resources on HIV associated nephropathy Discussion groups on HIV associated nephropathy Patient Handouts on HIV associated nephropathy Directions to Hospitals Treating HIV associated nephropathy Risk calculators and risk factors for HIV associated nephropathy
Healthcare Provider Resources
Symptoms of HIV associated nephropathy Causes & Risk Factors for HIV associated nephropathy Diagnostic studies for HIV associated nephropathy Treatment of HIV associated nephropathy
Continuing Medical Education (CME)
CME Programs on HIV associated nephropathy
International
HIV associated nephropathy en Espanol HIV associated nephropathy en Francais
Business
HIV associated nephropathy in the Marketplace Patents on HIV associated nephropathy
Experimental / Informatics
List of terms related to HIV associated nephropathy

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.

Incidence

Much more common in Black and African American patients with HIV. In the USA 12% of patients dying with AIDS have histologically proven HIVAN, the worldwide incidence amongst AIDS patients appears to be similar. A South African study at Tygerberg Hospital, Stellenbosch University, has shown HIVAN histology in 33/61(54%) biopsies performed in HIV positive patients.

Among black adults in the USA it is the third most common cause of ESRF.

Pathology

Involves all components of the nephron. Typical findings are that of collapsing FSGS (Focal segmental glomerulosclerosis)and mycrocystic tubular dilatation.

Treatment

There is as yet inadeqaute data from randomised controlled trials.

Treatment with HAART and ACE inhibitors/Angiotensin receptor blockers has been shown to be beneficial and should be given to all patients unless otherwise contra-indicated. General renoprotective measures and the treatment of the complications of nephrotic syndrome and renal failure are adjunctive.

Corticosteroid treatment can be useful in patients who do not respond to the above treatment. There is some evidence that cyclophosphamide might be helpful in selective cases, however further trials are required on both steroids and cyclophosphamide before these drugs can become standardised treatmen if at all.