HIV-associated nephropathy

HIV-associated nephropathy is manifested by heavy proteinuria and renal ins ufficiency and characterized pathologically by the collapsing variant of fo cal and segmental glomerulosclerosis with acute tubular necrosis and mild i nterstitial inflammation. Untreated, it may result in endstage renal diseas e in as little as 4 months. It may present in patients with any manifestati on of HIV infection, and affects predominantly black individuals. Insights into pathogenesis have come from a transgenic mouse model, renal cell cultu res, and from study of human biopsy material. Although the pathogenesis is not completely understood, current considerations revolve around the role o f HIV or protein in renal epithelium and the effects of cytokines, includin g transforming growth factor-p and basic fibroblast growth factor, on renal structures. Therapy with zidovudine, corticosteroids, or angiotensin-conve rting enzyme inhibitors has met with modest success; to date, protease inhi bitors have not been assessed.