Clinical Investigation

Kidney International (1989) 35, 1358–1370; doi:10.1038/ki.1989.135

Pathology of HIV-associated nephropathy: A detailed morphologic and comparative study

Vivette D'Agati1, Jung-Il Suh1, Laura Carbone1, Jen-Tse Cheng1 and Gerald Appel1

1Departments of Pathology and Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA

Correspondence: Vivette D'Agati MD, College of Physicians & Surgeons of Columbia University, Department of Pathology, 630 West 168th Street, New York, New York 10032, USA.

Received 14 April 1988; Revised 17 January 1989; Accepted 27 January 1989.

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Abstract

Pathology of HIV-associated nephropathy: A detailed morphologic and comparative study. Clinical and pathologic findings in the kidneys of 30 consecutive acquired immunodeficiency syndrome (AIDS) autopsies and in 34 consecutive renal biopsies performed on HIV infected patients at our institution between 1983 and 1987 were studied. To determine if the lesions of HIV-associated nephropathy have morphologic specificity, a subgroup of 13 biopsies with a diagnosis of HIV-associated nephropathy (HIVN) were compared to 13 biopsies each of heroin-associated nephropathy (HAN) and of idiopathic focal segmental glomerulosclerosis (IFSGS) matched for patient age, proteinuria and serum creatinine. A diagnosis of HIVN was made in 1 of 30 (3.3%) AIDS autopsies and 26 of 34 (76.5%) renal biopsies. When compared to HAN and IFSGS, HIVN had more globally "collapsed" glomeruli (P < 0.001), less glomerular hyalinosis (P < 0.02), more severe visceral epithelial cell swelling (P < 0.05), more numerous visceral epithelial cell droplets (P< 0.002), more prevalent and severe tubular microcystic dilatation (P < 0.02), and tubular cell degenerative changes (P < 0.001). Focal glomerular electron-dense deposits were present in 14 of 26 cases. Tubuloreticular inclusions were extremely numerous in glomerular and interstitial capillary endothelial cells as well as in interstitial leukocytes (P < 0.001). Granular degeneration of nuclear chromatin was present in 10 of 26 cases. Nuclear bodies were more numerous in tubular and interstitial cells of HIVN (P < 0.01), particularly type 3 (P < 0.001). Reversal of tissue T4/T8 ratio was observed. We conclude that while no single morphologic feature of HIVN is specific, the combination of clinical and pathologic findings is quite distinctive and permits a presumptive diagnosis of HIVN in otherwise asymptomatic carriers.

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References

  1. Niedt GW, Schinella RA: Acquired immunodeficiency syndrome. Arch Pathol Lab Med 109:727–734, 1985
  2. Gardenswartz MH, Lerner CW, Seligson GR, Zabetakis RM, Rotterdam H, Tapper ML, Michelis MR, Bruno MS: Renal disease in patients with AIDS: A clinicopathologic study. Clin Nephrol 21:197–204, 1984 | PubMed | ISI | ChemPort |
  3. Pardo V, Aldana M, Colton RM, Fischl MA, Jaffe D, Moskowitz L, Hensely GT, Bourgoignie JJ: Glomerular lesions in the acquired immunodeficiency syndrome. Ann Intern Med 101:429–434, 1984 | PubMed | ISI | ChemPort |
  4. Balow JE, Macher AM, Rook AH: Paucity of glomerular disease in acquired immunodeficiency syndrome. (abstract) Kidney Int 29:178, 1986
  5. Rao TKS, Friedman EA, Nicastri AD: The types of renal disease in the acquired immunodeficiency syndrome. N Engl J Med 316:1062–1068, 1987 | PubMed | ISI | ChemPort |
  6. Pardo V, Meneses R, Ossa L, Jaffe DJ, Strauss J, Roth D, Bourgoignie JJ: AIDS-related glomerulopathy: Occurrence in specific risk groups. Kidney Int 31:1167–1173, 1987 | PubMed | ISI | ChemPort |
  7. Carbone L, D'Agati V, Cheng J-T, Appel GB: The course and prognosis of HIV nephropathy. Am J Med (submitted for publication)
  8. Cohen AH, Nast CC: HIV-associated nephropathy: A unique combined glomerular, tubular and interstitial lesion. Modern Pathol 1:87–97, 1988 | ISI | ChemPort |
  9. Chander P, Soni A, Suri A, Bhagwat R, Yoo J, Treser G: Renal ultrastructural markers in AIDS-associated nephropathy. Am J Pathol 126:513–526, 1987 | PubMed | ISI | ChemPort |
  10. Humphreys MH, Schoenfeld PY: AIDS and renal disease. The Kidney 20:7–12, 1987
  11. Humphreys MH, Schoenfeld PY: Renal complications in patients with the acquired immune deficiency syndrome (AIDS). Am J Nephrol 7:1–7, 1987
  12. Bouteille M, Kalifar SR, Delarue J: Ultrastructural variations of nuclear bodies in human disease. J Ultrastruct Res 19:474–486, 1967 | Article | PubMed | ChemPort |
  13. Ghadially FN: Ultrastructural Pathology of the Cell and Matrix (2nd ed). Edited by FN Ghadially, London, Boston, Butter-worths, 1982, pp. 372–377
  14. D'Agati VD, Appel GB, Estes D, Knowles DM, Pirani CL: Monoclonal antibody identification of infiltrating mononuclear leukocytes in lupus nephritis. Kidney Int 30:573–581, 1986
  15. Falkoff GE, Ribsby CM, Rosenfield AT: Partial, combined cortical and medullary nephrocalcinosis. US and CT patterns in AIDS-associated MAI infection. Radiology 162:343–344, 1987
  16. Hui AN, Koss MN, Meyer PR: Necropsy findings in acquired immunodeficiency syndrome: A comparison of premortem diagnosis with postmortem findings. Hum Pathol 15:670–676, 1984
  17. Welch K, Finkbeiner W, Alpers CE, Blumenfeld W, Davis RL, Smuckler EA, Beckstead JH: Autopsy findings in the acquired immunodeficiency syndrome. JAMA 252:1152–1159, 1984
  18. Guarda LA, Luna MA, Smith JL: Acquired immunodeficiency syndrome: Postmortem findings. Am J Clin Pathol 81:549–557, 1984
  19. Reichert CM, O'Leary TJ, Levens DL: Autopsy pathology in the acquired immunodeficiency syndrome. Am J Pathol 112:357–382, 1983
  20. Singer FR, Adams JS: Abnormal calcium homeostasis in sarcoidosis. (editorial) N Engl J Med 315:755–757, 1986
  21. Vazir ND, Barbari A, Licorish K, Cesario T, Gupta S: Spectrum of renal abnormalities in acquired immunodeficiency syndrome. J Nat Med Assoc 77:369–375, 1985
  22. Cunningham EE, Brentjens JR, Zielezny MA, Andres GA, Venuto RC: Heroin nephropathy: A clinicopathologic and epidemiologic study. Am J Med 68:47–53, 1980 | PubMed |
  23. Bourgoignie JJ, Meneses R, Pardo V: The nephropathy related to acquired immune deficiency syndrome. Adv Nephrol 17:113–124, 1988
  24. Bertani T, Rocchi G, Sacchi G, Mecca G, Remuzzi G: Adriamycin induced glomerulosclerosis in the rat. Am J Kid Dis 7:12–19, 1986
  25. Sidhu GS, Stahl RS, El-Sadr W, Cassai ND, Forrester EM, Zolla-Pazner S: The acquired immunodeficiency syndrome: An ultrastructural study. Human Pathol 16:377–386, 1985
  26. Schaff Z, Barry DW, Grimley PM: Cytochemistry of tubulore-ticular structures in lymphocytes from patients with systemic lupus erythematosus and in cultured human lymphoid cells. Comparison to paramyxovirus. Lab Invest 29:577–586, 1973 | PubMed | ChemPort |
  27. Shamoto M, Murakami S, Zenke T: Adult T cell leukemia in Japan: An ultrastructural study. Cancer 47:1804–1811, 1981
  28. Rich SA, Owens TR: Inducibility of human lupus inclusions by interferons. J Cell Biochem (suppl 6):279A, 1982
  29. Preble OT, Vilcek J, Friedman-Kien AE, Friedman RM, Goedert JJ, Sonnabend JA: Acid-labile leukocyte interferon in homosexual men with Kaposi's sarcoma and lymphadenopathy, in The Acquired Immune Deficiency Syndrome and Infections of Homosexual Men edited by Ma P, Armstrong D, New York, Yorke Medical Books, 1984, p. 381
  30. Pardo V, Ortiz C, Strauss J, Bourgoignie JJ: Histologic and ultrastructural specificity of HIV-associated focal and segmental sclerosis. (abstract) Kidney Int 33:330, 1988
  31. Santibanez GP, Lafarga M: Nuclear bodies in the rat adrenal glomerular zone in normal and experimental conditions. A Mikrosk-Anat Forsch 93:951–958, 1979
  32. Krishan A, Uzman BG, Hedley-Whyte ET: Nuclear bodies: A component of cell nuclei in hamster tissues and human tumors. J Ultrastruct Res 19:563–572, 1967 | Article | PubMed | ChemPort |
  33. Schulze C: Giant nuclear bodies (sphaeridia) in Sertoli cells of patients with testicular tumors. J Ultrastruct Res 67:267–275, 1979
  34. Patrizi G, Middelkamp J: In vivo and in vitro demonstration of nuclear bodies in vaccinia-infected cells. J Ultrastruct Res 28:275–287, 1969
  35. Tomizaga A, Maruyama K, Nagasawa N, Suzuki S, Kuroume T: Studies of vascular permeability factor derived from B lymphocytes and inhibitory effect of plasma on its production in minimal change nephrotic syndrome. Nephron 41:157–287, 1985
  36. Averbuch SD, Austin NA, Shewin SA, Antonovych T, Bunn TA Jr, Longo TL: Acute interstitial nephritis with the nephrotic syndrome following recombinant leukocyte A interferon therapy for mycosis fungoides. N Engl J Med 310:32–35, 1984 | PubMed | ISI | ChemPort |
  37. Cohen AH, Sun NCJ, Shapshak P: HIV-associated nephropathy: Direct viral infection of kidneys? (abstract) Modern Path 1:19A, 1988

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