Sonographic evaluation of kidney echogenicity and morphology among HIV sero-positive adults at Lagos University Teaching Hospital.

AIM: To evaluate the role of kidney echogenicity and morphology in the diagnosis of human immunodeficiency virus-associated nephropathy (HIVAN). SUBJECTS AND METHODS: In the cross-sectional study, a sample of 340 anti-retroviral therapy (ART)-naïve AIDS patients underwent laboratory CD4+ count, serum creatinine determination and sonographic renal echogenicity grading and size measurement. Rounded kidneys were described as bulbous while bean-shaped kidneys were described as reniform; echogenicity was categorized into grades 0, 1, 2 and 3. Kidney length, width, thickness and volume were measured in HIVAN and control groups. RESULTS: Mean age of the population was 42.7 ± 9.4 years; 87.4% had HIVAN. Mean CD4+ count, serum creatinine and GFR for HIVAN patients were 153.1 ± 103.2 cells/mm3, 218.4 ± 147.4 mmol/L and 50.1 ± 23.6 mL/min/1.73 m2 for males and 121.9 ± 91.0 cells/mm3, and 222.0 ± 150.4 mmol/L and 39.3 ± 20.6 mL/min/1.73 m2 for females, respectively; control subjects and non-HIVAN patients had grade 0 renal echogenicity; 56.9% of HIVAN patients had echogenicity grade 3; 5.3% had kidney length < 10 cm; 73.9% had bulbous kidneys; the kidney was significantly wider and thicker in HIVAN (p < 0.05). CONCLUSION: Sonographic evaluation of renal echogenicity and morphology can reliably predict HIVAN diagnosis. Apathy to screening and late presentation were high while HIV/AIDS remains an important public health problem in the city of Lagos. Unilateral reduction in kidney size could be a major sequela of AIDS while sonographic measurement of absolute kidney length appears inadequate in the evaluation of AIDS patients with nephropathy.

[Patient from Gambia with sonographic white kidneys]. / Patient aus Gambia mit sonografisch weißen Nieren - Fall 7 / 2016.

HISTORY AND ADMISSION FINDINGS: A 39-year-old male refugee from Gambia is admitted to the emergency room with fever, body aches and productive cough. INVESTIGATIONS: Laboratory, ultrasound and CT investigations show a sepsis due to Staphylcoccus aureus, a renal failure with the appearance of "snow-white" kidneys on ultrasound and a previously unknown acute HIV-infection. DIAGNOSIS, TREATMENT AND COURSE: Broad antibiotic treatment and an antiretroviral therapy (adapted to the impaired renal function) as well as hemodialysis are commenced. Despite of successful sepsis treatment and viral load reduction, the kidney function does not recover. Histologically, a HIV-nephropathy is confirmed. CONCLUSIONS: The appearance of "snow-white" kidneys on ultrasound can be a characteristic sign of a HIV-associated nephropathy.

Clinical Scenarios in Chronic Kidney Disease: Parenchymal Chronic Renal Diseases - Part 2.

Secondary nephropathies can be associated with disreactive immunological disorders or with a non-inflammatory glomerular damage. In systemic lupus erythematosus (SLE), scleroderma and rheumatoid arthritis as in other connective tissue diseases, kidney volume and cortex echogenicity are the parameters that best correlate with clinical severity of the disease, even if the morphological aspect is generally non-specific. Doppler studies in SLE document the correlation between resistance indexes (RIs) values and renal function. Acquired immunodeficiency syndrome (HIV) causes different types of renal damage. At ultrasound (US), kidneys have almost a normal volume, while during superinfection they enlarge (coronal diameter >13 cm) and become globular, loosing their normal aspect. Cortex appears highly hyperechoic, uniform or patchy. Microcalcifications of renal cortex and medulla are a US sign that can suggest HIV. In amyloidosis, kidneys appear normal or increased in volume in the early stages of disease. Renal cortex is diffusely hyperechoic and pyramids can show normal size and morphology, but more often they appear poorly defined and hyperechoic. RIs are very high since the early stages of the disease. Nephromegaly with normal kidney shape is the first sign of lymphoma or multiple myeloma. In systemic vasculitis, renal cortex is diffusely hyperechoic, while pyramids appear hypoechoic and globular due to interstitial edema. When vasculitis determines advanced chronic kidney disease stages, kidneys show no specific signs. Microcirculation damage is highlighted by increased RIs values >0.70 in the chronic phase.

A longitudinal magnetization transfer imaging evaluation of brain injury in a macaque model of neuroAIDS.

Magnetization transfer (MT) imaging has been explored in prior studies of HIV patients and showed the potential capacity to assess brain injury after HIV infection. In the present study, adult pig-tailed macaques were infected with a highly neuropathogenic virus SIVsmmFGb. MT imaging was exploited to examine the monkey brains before simian immunodeficiency virus (SIV) inoculation and 2, 4, 8, 12, 16, and 20 weeks post-SIV inoculation. Blood samples were collected from each animal for monitoring CD4(+) and CD8(+) T cells before each MRI scan. The MT ratios (MTR) in several brain regions of interest were evaluated longitudinally. Significant reductions of MTR were observed in whole brain and selected regions of interest (genu, splenium, thalamus, caudate, centrum semiovale, frontal white matter, frontal gray matter, and putamen) in the SIV-infected monkeys, consistent with those reported previously in HIV patients. In particular, the longitudinal results indicate that abnormal MTR reduction can be detected as early as in 2 weeks and MTR may be more sensitive to the brain injury in cortical regions than in subcortical regions during acute SIV infection. In addition, MTR reduction in genu, centrum semiovale, and thalamus significantly correlated with the CD4(+) T cell percentage decrease. Also, the MTR reduction in thalamus correlated with the CD8(+) T cell percentage elevation. Taken together, this study reported the longitudinal evolution of MTR in different brain regions during SIV infection and further validates previous findings in HIV patients. The preliminary results suggest that MT imaging could be a robust and sensitive approach to characterize the neurodegeneration after SIV or HIV infection.

Renal and urologic disorders in antiretroviral-treated patients with HIV infection or AIDS: spectrum of cross-sectional imaging findings.

In the aging human immunodeficiency virus (HIV)-infected population with improved immune function under antiretroviral treatment, many different opportunistic disorders may be encountered, along with rare presentations or complicated forms of common diseases. Renal and urologic abnormalities observed in the setting of HIV infection or acquired immunodeficiency syndrome are reviewed with their imaging appearances, including renal dysfunction, urolithiasis, urinary tract infections and related complications, genitourinary tuberculosis, vascular lesions, urogenital tumors, and bladder abnormalities, with emphasis on characterization. In HIV-positive patients, early cross-sectional imaging is warranted to detect uncommon disorders and complications, with the aim to preserve renal function.

Determining the prevalence of human immunodeficiency virus-associated nephropathy (HIVAN) using proteinuria and ultrasound findings in a Nigerian paediatric HIV population.

BACKGROUND: HIV associated nephropathy (HIVAN) is the most common form of chronic kidney disease resulting directly from HIV infection. The true prevalence of HIVAN in the paediatric population of West Africa is unknown, largely due to lack of surveillance and reporting of kidney disease in HIV positive patients. METHODS: This was a prospective study over a six month period( July to December 2008) conducted in the Infectious Disease Unit of the Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria involving all confirmed cases of paediatric HIV infection. Urine microalbuminuria using calculated urine albumin - creatinine ratio was determined and repeated in 4 weeks interval. CD4 count and renal ultrasonography was done for all the patients. The correlation of urine albumin - creatinine ratio with CD4 count, duration of treatment with highly active antiretroviral therapy (HAART) and association with clinical staging of the disease was also examined. RESULTS: Fifty - nine (60.2%) were males, thirty - nine (39.8%) were females with male to female ratio of 1.5:1. The prevalence rate of 31.6% HIVAN was found, out of which 3.1% had abnormal ultrasound findings. There was a significant correlation between CD4 count and urine albumin - creatinine ratio (r=-0.22, p=0.03). There was no correlation between urine albumin - creatinine ratio and duration on HAART (r=-0.10, p=0.31). CONCLUSION: Screening for microalbuminuria is essential for the early diagnosis and treatment of HIVAN in this age group.

Sonographic characterization of renal pathologies in HIV/AIDS in Plateau State, Nigeria.

BACKGROUND: The prevalence of HIV/AIDS in Jos is about 7% according to Idoko et al. Many deaths from infection occur from the complications involving vital organs. The effects of this complication on the kidneys being one of the vital organs are yet to be determined in the locality. The kidneys are prone to impairment due to direct viral attack, opportunistic infections and nephrotoxic drugs. Though renal sonographic features are well characterized in literature, there is no documentation of correlation between renal sonographic features in HIV/AIDS and healthy population in Nigeria. The objectives of the study are to determine the commonly occurring renal sonographic features in HIV/AIDS in terms of echogenicity and size, and correlate these features with measured CD4 cell count. METHODS: 302 subjects were studied prospectively over a period of twenty two months. In order to determine renal sizes, several bilateral longitudinal and transverse scans of the subjects' kidneys in a supine position were done. In order to clarify renal echogenicity, a-four point scoring method was devised to measure the severity of sonographic changes in the kidneys. Subjects' CD4 cell counts were collected from the APIN laboratory and Faith Alive Foundation both in Jos. Pearson's correlation and regression were used for correlation between CD4 cell count and renal length, and between renal length and age, and Z-test was used to compare mean renal dimension of male and female of subjects and HIV sero negative subjects. RESULTS: The subjects consisted of 123 males and 179 females with a mean age of 34.4 years, between the ages of 4 and 80 years. Results indicated that 77.7% of subjects had increased renal echogenicity reflecting the prevalence of renal disease in HIV/AIDS in the locality, 76.7% of the subjects were in their reproductive and sexually active ages (21-40 years). There was significant negative correlation between renal length and measured CD4 cell count (p < 0.01) and also between renal length and age of subjects (p < 0.05). No significant correlation between renal echogenicity and CD4 cell count was noted. Result also indicate that renal length is related to CD4 cell count by the equation = 0.0029CD4+11.1423. CONCLUSION: It is concluded that sonographic features of the kidneys in HIV infection in this locality is characterized by increased renal length with decreasing CD4 cell count amongst sexually active age group. And also a generally high incidence of renal involvement (disease) in HIV/AIDS is seen, similar to those reported in literatures.

[Kidney ultrasound scan performed on the adult patient with HIV serology positive in the University Hospital of Tokoin and campus of Lome]. / Echographie renale chez le sujet adulte porteur du VIH aux CHU Tokoin et campus de Lome.

PURPOSES: To describe the elementary lesions, to list the kidney pathologies, to determine the kidney reach frequency and to establish an interrelationship enters the gravity of the kidney reach and the kidney's structure at the ultrasound scan. PATIENT AND METHOD: It was about a prospective survey of ten (10) month, realized in the Departments of radiology of the Teaching Hospitals of Lomé (CHU Tokoin and Campus), concerning 281 patients aged of 18 to 71 years whose HIV serology is positive. RESULTS: The radiological frequency of the HIV/AIDS infection noted during our period of survey was of 3.27% (281/8583). The modal age group was of 30-40 years (32.38%). The female representativeness was 56.92% against 43.08% of men. The drivers (23.13%) follow-ups of the tradesmen were the more touched. The bachelors were more exposed (38.43%). The kidney increased size in 31.85% of the cases. The majority of the patients (88.19%) was at the echographic advanced stage of the renal suffering of which 70.08% were at the III stage. The length of the kidneys was generally normal (74.38%), their width was normal in 53.38% of the cases and increased in 44.42% of the cases. As for the thickness, it was increased in general (71.88%). The kidney suffering (49.03%) was the most dominant pathology. CONCLUSION: The wealth of the kidney pathology associated to the infection of the HIV/AIDS should bring the practitioners to integrate the ultrasound scan in the balance of this affection.

Sonography as a predictor of human immunodeficiency virus-associated nephropathy.

OBJECTIVE: To determine whether renal sonography can be used to predict the pathologic diagnosis of human immunodeficiency virus-associated nephropathy. METHODS: This cross-sectional study evaluated 87 human immunodeficiency virus-positive patients who underwent both kidney biopsy and renal sonography after referral to the Johns Hopkins Renal Clinic from January 1995 to July 2002. Using a standardized measure of echogenicity, an independent blinded radiologist reviewed the original sonographic images. Sensitivity, specificity, positive and negative predictive values, receiver operating characteristic curves, and likelihood ratios were determined with the use of the biopsy pathologic report as the criterion standard. RESULTS: Thirty-four patients (39%) had biopsy-proved human immunodeficiency virus-associated nephropathy. A higher serum creatinine level, greater proteinuria, and black race were associated with human immunodeficiency virus-associated nephropathy, whereas age, sex, hypertension, and diabetes were not. Sensitivity and specificity for the highest 2 levels of echogenicity were 96% and 51%, respectively Sensitivity and specificity for the highest level of echogenicity were 40% and 95%. The likelihood ratio for the diagnosis of human immunodeficiency virus-associated nephropathy on the basis of the highest echogenicity score was 7.4 (95% confidence interval, 1.3-73.0; P = .006). The likelihood ratio for the lowest 2 echogenicity scores was 0.08 (95% confidence interval, 0.002-0.57; P = 0.003). Kidney size was not associated with human immunodeficiency virus-associated nephropathy status. CONCLUSIONS: This study provides evidence that, among patients with human immunodeficiency virus and kidney disease, the highest and lowest levels of sonographic echogenicity have diagnostic value in respectively establishing or excluding human immunodeficiency virus-associated nephropathy.

Diuretic MAG3 scintirenography in children with HIV nephropathy: diffuse parenchymal dysfunction.

UNLABELLED: HIV nephropathy (HIVN) is prevalent in 15%-56% of HIV-infected children and induces mild to severe progressive nephropathy. METHODS: A total of 33 renal diuretic scintirenographic studies with 99mTc-mercaptoacetyltriglycine (MAG3) were reviewed and analyzed from 23 HIV pediatric patients, 21 of whom had HIVN with varying degrees of renal impairment. Results were compared with 10 studies of control patients of matching ages. Visual interpretation of images and renograms as well as semiquantitative analyses were performed. Variables compared were size of kidneys, time of peak and one-half peak activities, residual (or retained) cortical activity at 20 min, ratio of cortical activity at 2.5-20 min, and ratio of kidney activity to kidney plus background activity at 2 min. The results of MAG3 renal studies were also compared with laboratory data pertaining to creatinine clearance in all patients and with sonography in 17 patients. RESULTS: In most patients with HIVN (18/21), the kidneys were larger than normal, with a diffuse parenchymal dysfunction (decreased uptake, slow processing, and increased retention of activity) and flat renograms, findings similar to those observed in other diffuse parenchymal diseases. In all patients with HIVN, semiquantitative analysis (paired t test) showed statistically significant differences from control patients for all variables. On ANOVA, a statistically significant correlation was found between most scintigraphic parameters and the severity of renal impairment. Of the 17 concurrent sonographic studies in HIVN patients, 7 showed no abnormalities, whereas the results of scintigraphy were abnormal. CONCLUSION: Diuretic MAG3 scintirenography shows nonspecific diffuse parenchymal dysfunction in pediatric patients with HIVN. Such dysfunction may provide corroborative evidence of HIVN and should be recognized when the test is performed for standard indications. Further work is necessary to prove that the test has indeed the high sensitivity and good correlation with the seventy of HIVN suggested in this population; the test may be useful to follow up the progression of disease and the effect of treatment.

Renal manifestations of AIDS in children.

Renal abnormalities in pediatric AIDS patients are common. The most common renal abnormality is HIV nephropathy, which usually progresses to end-stage renal disease. Other disorders discussed are related to infection, malignancy, and medications. This review illustrates several of the imaging findings seen in the kidneys of these patients.

[Renal insufficiency with AIDS: ultrasonographic aspects]. / Insuffisance rénale associée au SIDA: aspects échographiques.

UNLABELLED: Renal pathologic changes in AIDS involve various factors and can also occur in several other forms of renal disease. Renal sonography was prospectively performed in 31 patients with laboratory evidence of AIDS and renal insufficiency. All patients included in this study were without clinical manifestations (group II of the CDC) and without risk factors of AIDS. AIM: to characterize renal pathologic changes underlying the sonographic findings in these patients. Sonographic evaluation included determination of renal sizes and renal echogenicity according to standard grading system. Sonography showed normal-sized or enlarge-sized kidneys. Enlarged kidneys were generally due to increased thickness rather than length or width; small-sized kidneys were not observed. Grading echogenicity showed: grade 0 in 3 patients, grade I in none, grade II in 11 patients and grade III in 17 patients. In six patients, we found "spotted" echostructural figure due to several hypoechoic and rounded zones. Echogenicity increased with the severity of renal insufficiency. Our study suggests that renal abnormalities are varied and can occur in all stages in the course of the disease. The particular "spotted" figure associated with enlarged size at the expense of thickness of kidneys must draw radiologist's attention to the probability of AIDS lesions. Further studies with large populations must be performed to confirm our observations.

Diagnostic sonography of HIV-associated nephropathy: new observations and clinical correlation.

OBJECTIVE: HIV-associated nephropathy is an important cause of morbidity that is characterized clinically by uremia and proteinuria and histologically by focal segmental glomerulosclerosis. In the largest series yet analyzed to our knowledge, we describe new sonographic findings and record the prevalence of other findings. We review the sonographic findings in a large group of HIV-infected patients. MATERIALS AND METHODS: Seventy-six consecutive HIV-infected patients underwent renal sonography. Abnormalities seen on sonography were recorded. RESULTS: Of 152 kidneys imaged, sonography showed that 30 kidneys (20%) were enlarged. Abnormal echogenicity was present in 136 kidneys (89%). Eighty-one kidneys (53%) were globular; 58 (38%) had decreased corticomedullary definition; 74 (49%) had decreased renal sinus fat; and 66 (43%) had heterogeneous parenchyma, some with echogenic striations. CONCLUSION: Our data reveal several sonographic abnormalities that have not previously been described: decreased corticomedullary definition, decreased renal sinus fat, parenchymal heterogeneity, and globular renal configuration. These new findings were found mainly in patients with advanced HIV infection.

Acquired immunodeficiency syndrome (AIDS) of the abdominal organs: imaging features.

The liver, spleen, biliary tract, pancreas, and kidneys are commonly affected by opportunistic infection, malignancy, and inflammatory disorders during the course of human immunodeficiency virus (HIV) infection. Clinical manifestations of solid abdominal visceral involvement are protean and usually nonspecific, but it is important to establish a specific diagnosis promptly in these often critically ill patients. This presentation reviews the cross-sectional imaging spectrum of HIV-associated lesions of these organs.

Pelvocalyceal thickening in HIV-associated nephropathy.

BACKGROUND: Previously reported causes of renal pelvocalyceal thickening (PCT) include infection, acute tubular necrosis and obstruction. This study was performed to evaluate the significance of PCT noted sonographically in patients with hyperechoic native kidneys. METHODS: We evaluated sonograms of 178 consecutive patients with hyperechoic native (excluding small and hydronephrotic) kidneys for the presence of PCT, and reviewed medical charts of patients with this finding. We also reviewed sonograms of two control groups: 20 consecutive patients with nephrosis unrelated to human immunodeficiency virus (HIV) infection who underwent renal biopsy, and 30 consecutive patients with severe hypoalbuminemia unrelated to kidney disease. RESULTS: PCT was observed in 20 study patients with hyperechoic kidneys. HIV-associated nephropathy (HIVAN) was diagnosed in 15 patients (14 with bilateral PCT) in whom previously reported causes of this appearance were excluded. PCT was not observed in control patients. CONCLUSION: Renal PCT can occur in patients with HIVAN in the absence of HIV-related complications. PCT in HIVAN does not merely reflect nonspecific nephrosis or hypoalbuminemia. HIVAN should be considered if PCT is noted sonographically in hyperechoic kidneys, even in patients not clinically suspected of harboring HIV infection.

[HIV-associated nephropathy]. / Nefropatia associada ao HIV.

AIDS can affect many parenchymal organs but the renal involvement is of vital value for patient's prognosis. Sonography can easily analyse most of all renal insult even in those patients without symptoms.

AIDS: sonography of hyperechoic renal pyramids in renal candidiasis.

A 13-month-old patient with autoimmune deficiency syndrome had renal candidiasis. An abnormal renal sonographic pattern of hyperechoic renal pyramids was demonstrated. This abnormal sonographic finding should suggest renal candidiasis in an immune suppressed child. In the normal kidney of children, the pyramids are hypoechoic. This pattern has not been noted in previous publications. We report this case.

Renal diseases in patients with AIDS: sonographic findings.

This essay illustrates the spectrum of sonographic findings of various renal manifestations of AIDS. The most common renal abnormality in patients with AIDS is nephropathy, which is manifested by deterioration of renal function and proteinuria. Acute tubular necrosis, intrarenal infections, focal nephrocalcinosis, hydronephrosis, and neoplasms also may occur.

Diagnostic uses of nuclear medicine in AIDS.

Radionuclide imaging, if applied with an organ system approach, is useful in the diagnosis of the AIDS (acquired immunodeficiency syndrome)-related complex. Specific pathologic processes can be suspected on the basis of uptake patterns. The intensity and pattern of pulmonary uptake and concomitant nonpulmonary uptake of gallium provide guidelines for distinguishing among various opportunistic pulmonary pathogens. Gastrointestinal and extra-gastrointestinal tract uptake of gallium aids distinction among fungal, mycobacterial, and viral infections and neoplasms. Patterns of spleen uptake of technetium-99m sulfur colloid and gallium allow differentiation between neoplasm (Kaposi sarcoma) and infection (with mycobacteria). Skeletal and soft-tissue abnormalities can be characterized and differentiated on the basis of bone scan and other radionuclide scan findings. Thallium uptake in brain tumors (and not in areas of infection) allows brain lesion discrimination. In the proper clinical setting, AIDS nephropathy has a characteristic gallium uptake pattern. Cardiac abnormalities (including functional) can also be assessed with scintigraphy. With knowledge of these organ-specific patterns and with correlative imaging studies, the manifestations of AIDS can be differentiated and appropriate treatment instituted.