HIV-associated nephropathy: Case study and review of the literature

Human immunodeficiency virus type 1 (HIV-1)-seropositive patients are at ri sk for the development of a variety of acute and chronic renal diseases. Th e most common cause of chronic renal failure in HIV-1-seropositive patients is HIV-associated nephropathy (HIVAN). HIVAN occurs almost exclusively in black patients and the majority of published cases are of patients who pres ent with acquired immunodeficiency syndrome (AIDS). This disease is current ly the third leading cause of end-stage renal disease in blacks aged 20-64. Because HIV-1-seropositive patients may develop a wide variety of acute an d chronic renal diseases, definitive diagnosis requires renal biopsy. Emerg ing data suggest a direct role of HIV-1 infection of kidney cells in the pa thogenesis of HIVAN. There have been no well-controlled clinical trials in the treatment of HIVAN. The therapeutic agents with the most promise are an giotensin-converting enzyme inhibitors and antiretroviral medications. Long -term renal prognosis may be changing in the setting of improved aggressive antiretroviral therapy. Patient survival is determined primarily by the st age of HIV-1 infection. In this article, we present the case history of a p atient who developed HIVAN. We then review the current literature concernin g the epidemiology, differential diagnosis, etiology, and treatment of HIVA N.