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HIV-related renal disease and the utility of empiric therapy—not everyone needs to be biopsied

Nature Clinical Practice Nephrology volume 5, pages 20–21 (2009)Cite this article

Should everyone with HIV infection who has kidney disease undergo renal biopsy? This is a tough question to answer because of the range of potential causes, aggressiveness and treatments of renal disease in these individuals. A more appropriate question might be: is there any reason to treat kidney disease differently in a person with HIV? On the basis of the available literature, I would say no.

The diagnosis and management of kidney disease in HIV has changed since HIV-associated nephropathy (HIVAN) was first described in the 1980s. In the late 1980s and early 1990s, we struggled to understand a kidney disease so aggressive that it put patients on dialysis within 3 months of presentation and took the lives of 50% of patients within 1 year of starting dialysis.1,2,3 At the time, biopsies were performed, just as they are today for any form of renal failure that is progressive, aggressive, or does not respond to therapy. Fortunately, the clinical course of patients with HIV and kidney disease has dramatically changed over the past two decades. At the time of the initial description of HIVAN, the survival of patients with HIV was poor, and organ complications worsened the prognosis further. The introduction of protease inhibitors that suppress viral replication effectively has, however, prolonged patient survival and reduced the risk of organ damage.4

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  1. Duke University Medical Center, Box 3646, Durham, NC 27710, USA szcze001@mc.duke.edu

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  1. LA Szczech is Associate Professor of Medicine at Duke University Medical Center, Durham, NC, USA.,

    Lynda A Szczech

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The author has declared associations with the following companies: GlaxoSmithKline, of whose speakers' bureau she is a member and from which she has grant support, and Gilead Sciences, of whose speakers' bureau she is a member and for which she acts as a consultant.

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Szczech, L. HIV-related renal disease and the utility of empiric therapy—not everyone needs to be biopsied. Nat Rev Nephrol 5, 20–21 (2009). https://doi.org/10.1038/ncpneph0969

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