The association between HIV and kidney disease was first noted in 1984, when reports emerged of HIV-infected individuals who exhibited nephrotic-range proteinuria and rapid progression to end-stage renal disease. A wide spectrum of renal disorders is now known to occur in patients with HIV. In this Focus issue, leading experts from around the world discuss four of the most important issues surrounding HIV-related kidney disease in the era of highly active antiretroviral therapy. Encompassing epidemiology, pathogenesis, prevention and treatment in both developed and developing countries, this Focus provides a valuable and cutting-edge resource for clinicians and researchers.
An NPG library of relevant Practice Points, Viewpoints, Perspectives, Reviews, Original research and Case Studies is also provided.
Focus content is free until: 25 October 2009
REVIEWS
The nephrotoxic effects of HAART
Hassane Izzedine, Marianne Harris & Mark A. Perazella
doi:10.1038/nrneph.2009.142
Nature Reviews Nephrology 5, 563-573 (2009)
Highly active antiretroviral therapy (HAART) has a variety of adverse renal effects. Patients receiving HAART can develop acute kidney injury, which can progress to chronic kidney disease. HAART also contributes indirectly to kidney disease by increasing the risk of diabetes and hypertension. This Review describes the epidemiology, mechanisms and diagnosis of HAART-related kidney damage, with an emphasis on preventive management of risk factors such as intravascular volume depletion and pharmacological interactions.
Controversies in the pathogenesis of HIV-associated renal diseases
Leslie A. Bruggeman & Peter J. Nelson
doi:10.1038/nrneph.2009.139
Nature Reviews Nephrology 5, 574-581 (2009)
The two most common forms of HIV-related renal disease are HIV-associated nephropathy and a collection of immunoglobulin-related glomerulonephritides known as HIV immune complex kidney diseases. In this Review, Bruggeman and Nelson discuss the pathogenesis of these two diseases focusing on topics that remain points of controversy, such as mechanisms of infection within the kidney, modeling of disease in rodents, the contribution of host immune responses, and the source of the proliferating glomerular epithelial cell.
Renal transplantation in patients with HIV
Lynda A. Frassetto, Clara Tan-Tam & Peter G. Stock
doi:10.1038/nrneph.2009.140
Nature Reviews Nephrology 5, 582-590 (2009)
The presence of HIV has historically been viewed as a contraindication to transplantation because of the risks associated with immunosuppression in patients who are already immunocompromised, the lack of long-term outcomes data to justify the use of a limited supply of donor organs, and the possibility of viral transmission to surgical staff. Frassetto and colleagues examine the issues surrounding kidney transplantation in patients with HIV and describe a range of strategies that optimize outcomes in these individuals.
HIV and kidney disease in sub-Saharan Africa
June Fabian & Saraladevi Naicker
doi:10.1038/nrneph.2009.141
Nature Reviews Nephrology 5, 591-598 (2009)
Studies in Africa have reported differing prevalence rates of renal disease in HIV; however, extrapolation of US statistics suggests that between 770,000 and 2.6 million people in sub-Saharan Africa could have HIV-associated nephropathy. This Review provides a global overview of HIV-related kidney disease to set the scene for a detailed analysis of this issue in Africa. The authors proffer advice on how to prevent or slow progression of renal disease and outline options for renal replacement therapy.
© 2018 Macmillan Publishers Limited, part of Springer Nature. All Rights Reserved.
