PELVOCALYCEAL THICKENING IN HIV-ASSOCIATED NEPHROPATHY

Background: Previously reported causes of renal pelvocalyceal thickeni ng (PCT) include infection, acute tubular necrosis and obstruction. Th is study was performed to evaluate the significance of PCT noted sonog raphically in patients with hyperechoic native kidneys. Methods: We ev aluated sonograms of 178 consecutive patients with hyperechoic native (excluding small and hydronephrotic) kidneys for the presence of PCT, and reviewed medical charts of patients with this finding. We also rev iewed sonograms of two control groups: 20 consecutive patients with ne phrosis unrelated to human immunodeficiency virus (HIV) infection who underwent renal biopsy, and 30 consecutive patients with severe hypoal buminemia unrelated to kidney disease. Results: PCT was observed in 20 study patients with hyperechoic kidneys. HIV-associated nephropathy ( HIVAN) was diagnosed in 15 patients (14 with bilateral PCT) in whom pr eviously reported causes of this appearance were excluded. PCT was not observed in control patients. Conclusion: Renal PCT can occur in pati ents with HIVAN in the absence of HIV-related complications. PCT in HI VAN does not merely reflect nonspecific nephrosis or hypoalbuminemia. HIVAN should be considered if PCT is noted sonographically in hyperech oic kidneys, even in patients not clinically suspected of harboring HI V infection.