HIV associated nephropathy pathophysiology

Jump to navigation Jump to search

HIV associated nephropathy Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating HIV associated nephropathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

KUB X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

HIV associated nephropathy pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of HIV associated nephropathy pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on HIV associated nephropathy pathophysiology

CDC on HIV associated nephropathy pathophysiology

HIV associated nephropathy pathophysiology in the news

Blogs on HIV associated nephropathy pathophysiology

Directions to Hospitals Treating HIV associated nephropathy

Risk calculators and risk factors for HIV associated nephropathy pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2];Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[3]Krzysztof Wierzbicki M.D. [4]

Overview

HIV associated nephropathy (HIVAN) is mostly seen in patients of African decent. Some factors involving HIV associated nephropathy (HIVAN) pathology includes: HIV-1 replication in the kidney, HIV-1 gene products, increased proliferation, apoptosis and dedifferentiation of podocytes and polymorphysim of Apolipoprotein 1 (APOL1) polymorphysim gene.[1]

Pathogenesis

HIV associated nephropathy (HIVAN) is mostly seen in patients of African decent.[1]

Some factors involving HIV associated nephropathy (HIVAN) pathology includes:[1]

Pathogenesis

Viral Factors
  • Proviral DNA has been reported in the renal tissue of all patients with HIV associated nephropathy (HIVAN) even in those with negative HIV-1 RNA levels in plasma.[2]
  • HIV-1 can replicate in the kidney even in those patients who are on treatment.[3] 
  • HIV-1 gene products such as nef (negative effector) and vpr (viral protein r) are reported to be involved in the pathogenesis.[4]
  • Increased proliferation, apoptosis and dedifferentiation of podocytes have been reported in HIVAN.[3]
Genetic Factor

High risk alleles G1 (a missense mutation) and G2 (a frameshift deletion) for Apolipoprotein 1 (APOL1) are associated with HIVAN (APOL1 gene is on chromosome 22).[5]

Gross Pathology

On gross pathology, kidneys in HIV-associated nephropathy have the following features:[6]

  • Pale
  • Unevenly enlarged
  • Smooth cortical surface.

Microscopic Pathology

On microscopic pathology, kidneys in HIV-associated nephropathy have the following features:[6]

Histopathology of HIV-associated nephropathy
Light Microscopy[6] Electron Microscopy[6] Immunofluorescence[6]
    • Wrinkling and folding of the glomerular basement membrane (GBM)
    • Hypertrophied visceral epithelial cells  
    • Visceral epithelial cells foot process effacement.  
    • Numerous tubuloreticular inclusions (TRI)
    • Nuclear bodies

 

References

  1. 1.0 1.1 1.2 Waheed S, Atta MG (2014). "Predictors of HIV-associated nephropathy". Expert Rev Anti Infect Ther. 12 (5): 555–63. doi:10.1586/14787210.2014.901170. PMID 24655211.
  2. Izzedine H, Acharya V, Wirden M, Cluzel P, Sene D, Lucas GM; et al. (2011). "Role of HIV-1 DNA levels as clinical marker of HIV-1-associated nephropathies". Nephrol Dial Transplant. 26 (2): 580–3. doi:10.1093/ndt/gfq414. PMID 20624771.
  3. 3.0 3.1 Medapalli RK, He JC, Klotman PE (2011). "HIV-associated nephropathy: pathogenesis". Curr Opin Nephrol Hypertens. 20 (3): 306–11. doi:10.1097/MNH.0b013e328345359a. PMC 3153858. PMID 21358326.
  4. Atta MG (2010). "Diagnosis and natural history of HIV-associated nephropathy". Adv Chronic Kidney Dis. 17 (1): 52–8. doi:10.1053/j.ackd.2009.08.005. PMID 20005489.
  5. Kopp JB, Nelson GW, Sampath K, Johnson RC, Genovese G, An P; et al. (2011). "APOL1 genetic variants in focal segmental glomerulosclerosis and HIV-associated nephropathy". J Am Soc Nephrol. 22 (11): 2129–37. doi:10.1681/ASN.2011040388. PMC 3231787. PMID 21997394.
  6. 6.0 6.1 6.2 6.3 6.4 D'Agati V, Suh JI, Carbone L, Cheng JT, Appel G (1989). "Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study". Kidney Int. 35 (6): 1358–70. PMID 2770114.

Template:WH Template:WS