The Renal Pathological Findings in Japanese HIV-infected Individuals with CKD: a Clinical Case Series from a Single Center

Overview

Journal Clin Exp Nephrol

Publisher Springer

Specialty Nephrology

Date 2017 Jun 10

PMID 28597149

Citations 2

Authors

Masaki Hara

Kumiko Momoki

Masamitsu Ubukata

Akihito Ohta

Akiko Tonooka

Minoru Ando

Affiliations

Soon will be listed here.

Abstract

Background: Chronic kidney diseases (CKD) have emerged as a significant cause of morbidity and mortality in patients infected with human immunodeficiency virus (HIV). However, the detailed study of renal pathological findings currently remains unclear in these Japanese patients.

Methods: A retrospective cohort study was undertaken to investigate renal pathological findings between January 1996 and July 2016. Our study included 20 Japanese HIV-infected patients with CKD; 10 cases had undergone renal biopsies, and 10 cases had undergone autopsies, respectively. Moreover, in the 10 biopsied patients, their clinical courses as well as renal outcomes after renal biopsy were also reviewed.

Results: All of the patients had received combination antiretroviral therapy (cART). The 10 biopsy cases (mean age, 54 ± 14 years and duration of cART, 8 ± 5 years) included three cases of diabetic nephropathy (DMN), two of IgA nephropathy, two of cART-induced tubulointerstitial nephritis (TIN), one of minimal change disease, one case of only finding intrarenal arterioles, and one case without abnormal findings. Among those patients, their clinical courses were preferable except for in the DMN cases. In the autopsy cases (mean age, 52 ± 10 years and duration of cART, 5 ± 5 years), no distinct mesangial or membranous abnormalities were detected. Mild to moderate tubulointerstitial atrophies were observed in six cases. Intrarenal arteriosclerosis was identified in nine cases, and the proportion of global glomerulosclerosis seen was 8.4 ± 12.5%/100 glomeruli.

Conclusion: DMN and cART-induced TIN was noted in the biopsy cases. In the autopsy cases, renal arteriosclerosis, global glomerulosclerosis, and tubulointerstitial atrophy were remarkable. Early diagnosis of kidney diseases should be crucial to introduce optimal management, including controlling rigorous comorbidities and appropriate use of cART, to prevent further progression of CKD.

Citing Articles

Patterns of biopsy-proven renal disease in people living with HIV: 10 years experience in Sydney, Australia.

Turner D, Drak D, Gracey D, Anderson L BMC Nephrol. 2022; 23(1):148.

PMID: 35430806 PMC: 9014572. DOI: 10.1186/s12882-022-02695-w.

Prevalence of Chronic Kidney Disease and Poor Diagnostic Accuracy of Dipstick Proteinuria in Human Immunodeficiency Virus-Infected Individuals: A Multicenter Study in Japan.

Yanagisawa N, Muramatsu T, Koibuchi T, Inui A, Ainoda Y, Naito T Open Forum Infect Dis. 2018; 5(10):ofy216.

PMID: 30320149 PMC: 6176335. DOI: 10.1093/ofid/ofy216.

References

Yanagisawa N, Ando M, Ajisawa A, Imamura A, Suganuma A, Tsuchiya K . Clinical characteristics of kidney disease in Japanese HIV-infected patients. Nephron Clin Pract. 2011; 118(3):c285-91. DOI: 10.1159/000322278. View

DAgati V, Suh J, Carbone L, Cheng J, APPEL G . Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study. Kidney Int. 1989; 35(6):1358-70. DOI: 10.1038/ki.1989.135. View

Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K . Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009; 53(6):982-92. DOI: 10.1053/j.ajkd.2008.12.034. View

Izzedine H, Hulot J, Vittecoq D, Gallant J, Staszewski S, Launay-Vacher V . Long-term renal safety of tenofovir disoproxil fumarate in antiretroviral-naive HIV-1-infected patients. Data from a double-blind randomized active-controlled multicentre study. Nephrol Dial Transplant. 2005; 20(4):743-6. DOI: 10.1093/ndt/gfh658. View

Izzedine H, Harris M, Perazella M . The nephrotoxic effects of HAART. Nat Rev Nephrol. 2009; 5(10):563-73. DOI: 10.1038/nrneph.2009.142. View

Szczech L, Gupta S, Habash R, Guasch A, Kalayjian R, Appel R . The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. Kidney Int. 2004; 66(3):1145-52. DOI: 10.1111/j.1523-1755.2004.00865.x. View

Brewster U, Perazella M . Acute interstitial nephritis associated with atazanavir, a new protease inhibitor. Am J Kidney Dis. 2004; 44(5):e81-4. View

Praditpornsilpa K, Napathorn S, Yenrudi S, Wankrairot P, Tungsaga K, Sitprija V . Renal pathology and HIV infection in Thailand. Am J Kidney Dis. 1999; 33(2):282-6. DOI: 10.1016/s0272-6386(99)70301-x. View

Horberg M, Tang B, Towner W, Silverberg M, Bersoff-Matcha S, Hurley L . Impact of tenofovir on renal function in HIV-infected, antiretroviral-naive patients. J Acquir Immune Defic Syndr. 2009; 53(1):62-9. DOI: 10.1097/QAI.0b013e3181be6be2. View

10.

Couser W . Basic and translational concepts of immune-mediated glomerular diseases. J Am Soc Nephrol. 2012; 23(3):381-99. DOI: 10.1681/ASN.2011030304. View

11.

Doi A, Iwata K, Hara S, Imai Y, Hasuike T, Nishioka H . Interstitial nephritis caused by HIV infection by itself: a case report. Int J Gen Med. 2016; 9:311-4. PMC: 5012837. DOI: 10.2147/IJGM.S115393. View

12.

Nebuloni M, Barbiano di Belgiojoso G, Genderini A, Tosoni A, L N, Riani . Glomerular lesions in HIV-positive patients: a 20-year biopsy experience from Northern Italy. Clin Nephrol. 2009; 72(1):38-45. DOI: 10.5414/cnp72038. View

13.

Gupta V, Gupta S, Sinha S, Sharma S, Dinda A, Agarwal S . HIV associated renal disease: a pilot study from north India. Indian J Med Res. 2013; 137(5):950-6. PMC: 3734688. View

14.

Mocroft A, Lundgren J, Ross M, Law M, Reiss P, Kirk O . A clinically useful risk-score for chronic kidney disease in HIV infection. J Int AIDS Soc. 2014; 17(4 Suppl 3):19514. PMC: 4224906. DOI: 10.7448/IAS.17.4.19514. View

15.

Hailemariam S, Walder M, Burger H, Cathomas G, Mihatsch M, Binswanger U . Renal pathology and premortem clinical presentation of Caucasian patients with AIDS: an autopsy study from the era prior to antiretroviral therapy. Swiss Med Wkly. 2001; 131(27-28):412-7. DOI: 10.4414/smw.2001.09698. View

16.

Kanzaki G, Tsuboi N, Miyazaki Y, Yokoo T, Utsunomiya Y, Hosoya T . Diffuse tubulointerstitial nephritis accompanied by renal crystal formation in an HIV-infected patient undergoing highly active antiretroviral therapy. Intern Med. 2012; 51(12):1543-8. DOI: 10.2169/internalmedicine.51.7093. View

17.

Ahuja T, Borucki M, Funtanilla M, Shahinian V, Hollander M, Rajaraman S . Is the prevalence of HIV-associated nephropathy decreasing?. Am J Nephrol. 1999; 19(6):655-9. DOI: 10.1159/000013537. View

18.

Foy M, Estrella M, Lucas G, Tahir F, Fine D, Moore R . Comparison of risk factors and outcomes in HIV immune complex kidney disease and HIV-associated nephropathy. Clin J Am Soc Nephrol. 2013; 8(9):1524-32. PMC: 3805081. DOI: 10.2215/CJN.10991012. View

19.

Booth J, Hamzah L, Jose S, Horsfield C, ODonnell P, McAdoo S . Clinical characteristics and outcomes of HIV-associated immune complex kidney disease. Nephrol Dial Transplant. 2016; 31(12):2099-2107. DOI: 10.1093/ndt/gfv436. View

20.

Berliner A, Fine D, Lucas G, Rahman M, Racusen L, Scheel P . Observations on a cohort of HIV-infected patients undergoing native renal biopsy. Am J Nephrol. 2008; 28(3):478-86. DOI: 10.1159/000112851. View