Clinicopathological analysis of patients with human immunodeficiency virus infection and nephropathy

Abstract

Objective To investigate the pathological characteristic of patients with human immunodeficiency virus (HIV) infection complicated with nephropathy and renal tissue biopsy. Methods Patients with HIV-associated nephropathy confirmed by renal biopsy in Department of Nephrology, West China Hospital of Sichuan University from January 2011 to December 2018 were collected. The pathological features, intervention and prognosis were analyzed, retrospectively. Results Nine patients were enrolled, including 6 cases with nephrotic syndrome, 1 case with acute kidney injury and 2 cases with chronic nephritis syndrome. Histological diagnosis results showed that 3 cases were with minor change, 1 case with membranous nephropathy, 1 case with collapsed focal segmental glomerular sclerosis (FSGS) and membranous nephropathy, 1 case with FSGS-not otherwise specified (NOS), 1 case with acute interstitial nephritis, 1 case with IgA nephropathy, 1 case with diabetic nephropathy. HIV infection was first diagnosed in 5 cases at the time of renal biopsy (including 1 case with collapsed FSGS complicated with membranous nephropathy, 1 case with diabetic nephropathy, 1 case with acute interstitial nephritis, and 2 cases with minor change disease). The other 4 cases developed renal disease at different stages (all receiving antiretroviral therapy) after the diagnosis of HIV infection. Among them, 1 case accompanied with diabetes, 1 case with syphilis infection, 2 cases with hypothyroidism and 3 cases with hepatitis B virus infection. During the following up, no severe infection case was observed. After treatment, 2 cases remained heavy proteinuria, 4 cases reached complete remission. Conclusions Besides HIV associated nephropathy (HIVAN), renal diseases with the HIV infection background include diabetic nephropathy, minor change disease, membranous nephropathy, FSGS, acute interstitial nephritis, IgA nephropathy and so on. They may manifest different clinical syndrome such as acute kidney injury, nephrotic syndrome, chronic nephritis. Renal biopsy is crucial to diagnose and treat the diseases. HIV screening in patients with kidney disease is important. In the case of effective antiretroviral therapy, targeted administration of glucocorticoids and cytotoxic drugs is safe. Multidisciplinary cooperation including doctors from department of nephrology, infectious disease, pathology and clinical pharmacy may improve the prognosis of HIV infected patients with renal diseases. Key words: Human immunodeficiency virus; Kidney disease; Renal biopsy