RENAL INVOLVEMENT DURING INFECTION WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Among the many renal complications of infection with the human immunodeficiency virus (HIV), HIV-associated nephropathy is specific and irreversible. Main symptoms in children and adults include proteinuria, with or without nephrotic syndrome, and renal failure. Histologic studies usually show mesangial hyperplasia and segmental, focal glomerulosclerosis with microcystic tubule dilatation. Severe proteinuria has been reported in 1.5 to 9 % of children with symptomatic HIV infection and has been found to be more common in black children. Renal laboratory test abnormalities have been detected in up to 40 % of patients. The incidence of HIV-associated nephropathy approximated 2 % in early European studies. In the author's study of 39 patients infected with the HIV in utero, only one patient (2.5 %) had evidence of renal disease (moderate proteinuria with no nephrotic syndrome). All these infants were given zidovudine (AZT) at the time of diagnosis. The pathogenesis of HIV-associated nephropathy remains incompletely elucidated, although evidence supporting a direct cytopathic effect of the HIV has been reported. No effective treatment is available and end-stage renal failure occurs shortly after onset of the disease. Tests to detect HIV-associated nephropathy should be performed routinely.