Pathogenesis and treatment of HIV-associated renal diseases: lessons from clinical and animal studies, molecular pathologic correlations, and genetic investigations

Article Abstract:

HIV infection is associated with severe renal syndromes, including acute renal failure. Chronic renal failure directly linked to HIV infection includes thrombotic microangiopathic renal diseases, immune-mediated glomerulonephritides, and HIV-associated nephropathy. A renal biopsy may be necessary for diagnosis. The development of HIV-associated nephropathy has been definitively linked to renal cellular infection, but the disease affects only a minority of patients, typically men of African descent. Therefore, factors determining disease expression in infected patients must now be emphasized. The pathogenic mechanisms involved in HIV-associated renal disease remain obscure. Genetic factors, as well as renal cellular responses, mediated by HIV proteins (including an immune-activated microenvironment) capable of presenting antigen in susceptible hosts probably explain most cases. HIV-associated nephropathy has a characteristic pathologic phenotype, including glomerular, tubular, and interstitial changes, and ultrastructural findings. Infection of the glomerular epithelial cell, or podocyte, and consequent structural and biochemical changes may be pivotal in pathogenesis. The HIV-1 transgenic mouse is an important model for understanding disease pathogenesis, particularly the role of HIV proteins in mediating renal tissue injury. Rigorously controlled randomized trials have not evaluated treatment, but corticosteroids and angiotensin-converting enzyme inhibitors have been used. Highly active antiretroviral therapy seems to have decreased the incidence of end-stage renal disease related to HIV infection and, in case reports, to have improved renal functional and pathologic outcomes of HIV-associated nephropathy. Outcomes in patients undergoing hemodialysis and peritoneal dialysis have improved, and current research focuses on renal transplantation for treatment of HIV-infected patients.

Care and treatment, Physiological aspects, HIV infection, HIV infections, Kidney diseases, Author Abstract

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Crystalluria and urinary tract abnormalities associated with indinavir

Article Abstract:

The drug indinavir produces easily recognizable crystals in the urine of the patient taking it and may be associated with painful urination or other kidney disorders. Indinavir is the most widely-used protease inhibitor among HIV-infected patients. Urine samples were taken from 142 HIV-infected patients who were taking indinavir and had no urological symptoms. Indinavir crystals were present in the urine of 29 (20%) patients. No crystals were found in the urine of 40 patients who were not taking the drug.

Protease inhibitors, Kidney stones, Indinavir (Medication)

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VEGF inhibition and renal thrombotic microangiopathy

Article Abstract:

The report describes the cases of six patients treated with vascular endothelial growth factor inhibitor bevacizumab, who developed glomerular disease characteristic of thrombotic microangiopathy. This was due to a reduction in glomerular VEGF, a direct, on-target effect of the drug.

United States, Reports, Risk factors, Dosage and administration, Vascular endothelial growth factor, Hemolytic anemia, Bevacizumab

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