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HIV-associated nephropathy: links, risks and management

Authors Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA, Atta MG

Received 20 January 2018

Accepted for publication 13 March 2018

Published 25 May 2018 Volume 2018:10 Pages 73—81


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Bassel Sawaya

Laura Palau,1,* Steven Menez,1,* Javier Rodriguez-Sanchez,1 Tessa Novick,1 Marco Delsante,2 Blaithin A McMahon,1 Mohamed G Atta1

1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 2Department of Pathology, Johns Hopkins University, Baltimore, MD, USA

*These authors contributed equally to this work

Abstract: Despite the decreased incidence of human immunodeficiency virus (HIV)-associated nephropathy due to the widespread use of combined active antiretroviral therapy, it remains one of the leading causes of end-stage renal disease (ESRD) in HIV-1 seropositive patients. Patients usually present with low CD4 count, high viral load and heavy proteinuria, with the pathologic findings of collapsing focal segmental glomerulosclerosis. Increased susceptibility exists in individuals with African descent, largely due to polymorphism in APOL1 gene. Other clinical risk factors include high viral load and low CD4 count. Advanced kidney disease and nephrotic range proteinuria have been associated with progression to ESRD. Improvement in kidney function has been observed after initiation of combined active antiretroviral therapy. Other treatment options, when clinically indicated, are inhibition of the renin–angiotensin system and corticosteroids. Further routine management approaches for patients with chronic kidney disease should be implemented. In patients with progression to ESRD, kidney transplant should be pursued, provided that viral load control is adequate. Screening for the presence of kidney disease upon detection of HIV-1 seropositivity in high-risk populations is recommended.

Keywords: HIVAN, HIV, APOL1 polymorphism, ESRD, kidney transplant

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