Acute renal failure in the course of HIV infection: a single-institution retrospective study of ninety-two patients and sixty renal biopsies

Background. Acute renal failure syndromes are frequently encountered in pat ients with human immunodeficiency virus (HIV) infection. Most reported case s of acute renal failure are related to acute tubular necrosis, but many ot her causes of renal failure have been described in these patients. Methods. The present work is a single-institution retrospective study of 92 HN-infected patients with acute or rapidly progressing renal failure. In 6 0 cases, a renal biopsy was performed. For each patient we analysed clinica l and pathological data, as well as the shortterm prognosis. Results, Ten different causes of acute or rapidly progressing renal failure were documented: (i) haemolytic uraemic syndrome (32 patients); (ii) acute tubular necrosis either of ischaemic-toxic origin (18 patients) or due to rhabdomyolysis (six patients); (iii) obstructive renal failure which was ei ther extrinsic (two patients), drug-induced (13 patients) or secondary to p araprotein precipitation (one patient); (iv) HIV-associated nephropathy (14 patients); (v) acute interstitial nephritis (two patients); (vi) various g lomerulonephritis (four patients). In most cases, renal failure was severe (the mean creatinine clearance at entry was 12 ml/min). Most patients had a significant improvement in renal function with only symptomatic treatment. Eighteen per cent of the patients died within 2 months of the diagnosis of renal failure. Renal biopsy seems important for the diagnosis but also for the prognosis, at least in the cases of haemolytic-uraemic syndrome, HIV-a ssociated nephropathy and drug-induced micro-obstructive renal failure. Conclusion. Vascular and glomerular diseases are frequent causes of acute o r rapidly progressing renal failure in HIV-infected patients. Renal biopsy appears to be safe and useful for the diagnosis and the prognosis of the re nal failure. High mortality rate is only observed in patients with ischaemi c/toxic causes of acute final failure.