genitourinary disorders
HIV Associated Nephropathy
Diagnosis of HIV Associated Nephropathy
Renal biopsy HIV-associated nephropathy is suspected in patients with nephrotic syndrome or nephropathy who have AIDS or symptoms of AIDS. HIV-associated nephropathy should be distinguished from the many other disorders that occur with higher frequency in HIV-infected patients and cause renal disease, such as thrombotic microangiopathy ( Hemolytic-Uremic Syndrome (HUS) and Ultrasonography, if done, shows that the kidneys are enlarged and highly echogenic. typically is done. Light microscopy shows capillary collapse of varying severity (collapsing glomerulopathy) and differing degrees of increased mesangial matrix. Tubular cells show marked degenerative changes and tubular atrophy or microcytic dilation. Interstitial immune cell infiltrate, fibrosis, and edema are common. Tubular reticular inclusions, similar to those in Systemic Lupus Erythematosus (SLE) , are found within endothelial cells but are now rare with more effective HIV therapy. Focal segmental glomerulosclerosis with collapse of glomerular tufts and microcystic tubular changes is characteristic of HIV-associated nephropathy (Jones silver stain,×100). Image provided by Agnes Fogo, MD, and the American Journal of Kidney Diseases'Atlas of Renal Pathology(see www.ajkd.org). HIV-associated nephropathy can be distinguished from focal segmental glomerulosclerosis by reticular inclusions in endothelial cell cytoplasm on transmission electron microscopy (×20,000). However, these reticular inclusions are now rare with use of highly active antiretroviral therapy. Image provided by Agnes Fogo, MD, and the American Journal of Kidney Diseases'Atlas of Renal Pathology(see www.ajkd.org). Normotension and persistently enlarged kidneys help to differentiate HIV-associated nephropathy from focal segmental glomerulosclerosis. 