HIV in Children

HIV AND RENAL MANIFESTATIONS

Dr. Ira Shah
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Last Updated : 1st September 2012

History


In 1984, physicians in New York and Miami reported HIV-infected adult patients with heavy proteinuria and rapid progression to end-stage renal disease. These patients showed large edematous kidneys with combination of focal segmental glomerulosclerosis (FSGS) and tubulointerstitial lesions. This renal syndrome, named HIV-associated nephropathy (HIVAN), was found predominantly in African Americans. Subsequent studies confirmed the presence of HIVAN in children in America & Africa, who frequently develop nephrotic syndrome in association with focal segmental glomerulosclerosis (FSGS) and/or mesangial hyperplasia with microcystic tubular dilatation. Subsequent studies have documented a range of renal manifestations in HIV infected children.

Glomerulopathy occurs in up to 15% of children with HIV infection whereas the occurrence of tubular dysfunction is less well defined.

HIV and renal involvement


A variety of renal abnormalities among HIV-infected patients have been described. These include HIV associated nephropathy (HIVAN), HIV-related immune complex disease, nephropathy secondary to antiretroviral therapy (ART) or antibiotics, thrombotic microangiopathy, and diseases related to common comorbidities such as opportunistic infections. The broad spectrum of clinical presentation includes acute renal failure (ARF), nephrotic syndrome, progressive chronic renal dysfunction, proteinuria, tubular function abnormalities and electrolyte disturbances. Several studies have found that HIV associated renal disease is seen with low CD4 + count and increased viral loads. Thus, all children with advanced HIV disease should be screened for renal disease.

HIV and proteinuria


A variety of renal abnormalities among HIV-infected patients have been described. These include HIV associated nephropathy (HIVAN), HIV-related immune complex disease, nephropathy secondary to antiretroviral therapy (ART) or antibiotics, thrombotic microangiopathy, and diseases related to common comorbidities such as opportunistic infections. The broad spectrum of clinical presentation includes acute renal failure (ARF), nephrotic syndrome, progressive chronic renal dysfunction, proteinuria, tubular function abnormalities and electrolyte disturbances. Several studies have found that HIV associated renal disease is seen with low CD4 + count and increased viral loads. Thus, all children with advanced HIV disease should be screened for renal disease.

HIV AND RENAL MANIFESTATIONS
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.