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The spectrum of kidney biopsy findings in HIV-infected patients in the modern era
The spectrum of kidney biopsy findings in HIV-infected patients in the modern era
- Source :
- Kidney International. 97:1006-1016
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- HIV-associated kidney disease is evolving rapidly. Few North American studies have addressed modern trends and none has applied the 2018 Kidney Disease Improving Global Outcomes (KDIGO) pathologic classification. Therefore we performed a retrospective clinical-pathologic analysis of all HIV-positive patients with kidney biopsy interpreted at Columbia University from 2010-2018 using the KDIGO classification. The biopsy cohort of 437 HIV-positive patients had median age 53 years, including 66% males, 80% on anti-retroviral therapy, 57% with hypertension, 31% with diabetes, 27% with hepatitis C and 6% with hepatitis B co-infections. Race, known in 308 patients, included 58% black, 25% white and 17% Hispanic. Pathologic diagnoses were surprisingly diverse. Immune complex glomerulonephritis (ICGN) and diabetic nephropathy each outnumbered HIV-associated nephropathy, followed by tenofovir nephrotoxicity, FSGS- not otherwise specified (NOS) and global sclerosis (NOS). HIV-associated nephropathy was the most common disease in patients not on anti-retroviral therapy, and 94% were black. The association of FSGS (NOS) with black race (68%) and anti-retroviral therapy use (77%) suggests some cases may represent attenuated HIV-associated nephropathy. The most common ICGNs were IgA nephropathy and membranous glomerulopathy, both associating with anti-retroviral therapy (over 90%), followed by hepatitis C-associated proliferative ICGN. Among the 16 cases of uncharacterized ICGN lacking identifiable etiology, 69% were not on anti-retroviral therapy, possibly representing true HIV-associated immune complex kidney disease. Dual diseases occurred in 17% of patients, underscoring lesion complexity. Thus, anti-retroviral therapy has shifted the landscape of HIV-associated kidney disease toward diverse ICGN, diabetic nephropathy, and non-collapsing glomerulosclerosis, but has not eradicated HIV-associated nephropathy.
- Subjects :
- Male
0301 basic medicine
medicine.medical_specialty
Biopsy
030232 urology & nephrology
HIV Infections
Kidney
Gastroenterology
Nephropathy
Diabetic nephropathy
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
Humans
Medicine
AIDS-Associated Nephropathy
Retrospective Studies
Hepatitis
business.industry
Glomerulosclerosis
Hepatitis C
Middle Aged
Hepatitis B
medicine.disease
030104 developmental biology
Nephrology
Female
business
Kidney disease
Subjects
Details
- ISSN :
- 00852538
- Volume :
- 97
- Database :
- OpenAIRE
- Journal :
- Kidney International
- Accession number :
- edsair.doi.dedup.....7757a9eb9a5a153525097065778df0f6
- Full Text :
- https://doi.org/10.1016/j.kint.2020.01.018