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Tubulointerstitial nephropathies in HIV-infected patients over the past 15 years: a clinico-pathological study. | LitMetric

AI Article Synopsis

  • Over the past 15 years, the management of HIV has improved significantly, leading to new patterns of kidney complications, particularly tubulointerstitial nephropathies in HIV-infected patients.
  • A study reviewed 59 renal biopsies from patients with HIV, finding that 26.6% showed tubulointerstitial nephropathies, predominantly as tubulopathy (49%) and interstitial nephritis (51%).
  • The leading cause was drug-related nephrotoxicity, with tenofovir being the primary culprit, emphasizing the need for awareness regarding these kidney issues and their treatment implications in HIV patients.

Article Abstract

Background And Objectives: The therapy and outcome of HIV infection have dramatically changed over the last 15 years, resulting in a change in renal complications. This study analyzed the characteristics of HIV-infected patients and biopsy-proven tubulointerstitial nephropathies to define disease patterns and therapeutic implications.

Design, Setting, Participants, & Measurements: A clinico-pathologic retrospective study of 59 consecutive renal biopsies showing predominant tubular and/or interstitial lesions in HIV-infected patients referred to the nephrology department between 1995 and 2011 was performed. HIV-associated nephropathy and vascular diseases were excluded from the study.

Results: Tubulointerstitial nephropathies accounted for 26.6% of 222 native renal biopsies performed in HIV-infected patients. Two pathologic groups were analyzed, tubulopathy and interstitial nephritis, which represented 49% and 51% of tubulointerstitial nephropathies, respectively. Most patients presented with AKI (76.3%) and high-grade proteinuria (57.7%). Drug-related nephrotoxicity was the leading cause (52.5%). Alternative etiologies included infections (15.2%), dysimmune disorders (8.5%), malignancies (3.4%), and chronic (10.2%) and acute (10.2%) tubulointerstitial nephropathies of undetermined origin. Tubulopathy was strongly associated with antiretroviral drug toxicity (75.9%) and mostly caused by tenofovir (55.2%), which was associated with proximal tubular dysfunction (87.5%), overt Fanconi's syndrome (37.5%), and nephrogenic diabetes insipidus (12.5%). Interstitial nephritis was associated with a broader spectrum of pathologic lesions and etiologies.

Conclusions: In this series, tubulointerstitial nephropathies accounted for 26.6% of renal diseases in HIV-infected patients. Considering the therapeutic implications of diagnoses of drug toxicity, infection, and dysimmune syndromes, this study underscores the importance of monitoring renal parameters in HIV-infected patients and points to the relevance of kidney biopsy to allow an accurate diagnosis.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675854PMC
http://dx.doi.org/10.2215/CJN.10051012DOI Listing

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