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Renal biopsy is necessary for the diagnosis of HIV-associated renal diseases

Nature Clinical Practice Nephrology volume 5, pages 22–23 (2009)Cite this article

HIV-associated nephropathy (HIVAN) is the most common cause of chronic kidney disease (CKD) in HIV-infected patients,1,2 and its pathogenesis is intimately linked with the viral disease.1,2 Although there is a spectrum of HIV-associated renal diseases,1,3,4 many are only indirectly related to the viral illness.1,4 Several renal syndromes—including CKD, acute kidney injury (AKI), and the nephritic and nephrotic syndromes—also affect HIV-infected patients.1,4,5

In an early study of HIV-infected patients with nephrotic-range proteinuria, renal biopsies showed that while 53.6% of patients had HIVAN, 28.6% had glomerulonephritis, some had diabetic nephropathy (presumably unrelated to HIV infection), and others had unsuspected AKI.6 Such diagnoses could not have been made from the clinical data in the absence of renal biopsies. Szczech and colleagues3 reported similar findings during the highly active antiretroviral therapy (HAART) era: almost half of the patients with HIV infection who underwent renal biopsy had HIVAN, but more than a third had immune complex glomerulonephritis or membranous, membranoproliferative, IgA or diabetic nephropathies. A recent study showed that 40% of patients with HIV infection and nephropathy had HIVAN, but 34% had various glomerulonephritides of uncertain etiology.7 In patients with HIV infection, many renal diseases (e.g. AKI, thrombotic microangiopathies, or nephropathies associated with diabetes, cryoglobulinemia or amyloidosis) can mimic HIVAN, but each condition requires a different therapy.1,4,5,8

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Acknowledgements

The opinions expressed in this paper are solely those of the authors and in no way should be seen as an official policy or recommendation of the NIH or the US government.

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  1. SD Cohen is Clinical Instructor in the Division of Nephrology, Department of Medicine at the College of Physicians and Surgeons of Columbia University, New York, NY, USA.,

    Scott D Cohen

  2. PL Kimmel is Professor of Medicine in the Division of Renal Diseases and Hypertension in the Department of Medicine at the George Washington University Medical Center, and Director of the HIV Kidney Program in the Division of Kidney, Washington DC, Urologic and Hematologic Diseases at the National Institute of Diabetes, Digestive and Kidney Diseases at the National Institutes of Health, Bethesda, MD, USA.,

    Paul L Kimmel

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Correspondence to Paul L Kimmel.

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Cohen, S., Kimmel, P. Renal biopsy is necessary for the diagnosis of HIV-associated renal diseases. Nat Rev Nephrol 5, 22–23 (2009). https://doi.org/10.1038/ncpneph0990

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