HIV-related nephropathy: new aspects of an old paradigm.

The scenario of infection by the human immunodeficiency virus (HIV) has been undergoing changes in recent years, both in relation to the understanding of HIV infection and regarding the treatments available. As a result, the disease, which before was associated with high morbidity and mortality, is now seen as a chronic disease that can be controlled, regarding both transmission and symptoms. However, even when the virus replication is well controlled, the infected patient remains at high risk of developing renal involvement, either by acute kidney injury not associated with HIV, nephrotoxicity due to antiretroviral drugs, chronic diseases associated with increased survival, or glomerular disease associated to HIV. This review will cover the main aspects of kidney failure associated with HIV.

HIV-related nephropathy: new aspects of an old paradigm

SUMMARY The scenario of infection by the human immunodeficiency virus (HIV) has been undergoing changes in recent years, both in relation to the understanding of HIV infection and regarding the treatments available. As a result, the disease, which before was associated with high morbidity and mortality, is now seen as a chronic disease that can be controlled, regarding both transmission and symptoms. However, even when the virus replication is well controlled, the infected patient remains at high risk of developing renal involvement, either by acute kidney injury not associated with HIV, nephrotoxicity due to antiretroviral drugs, chronic diseases associated with increased survival, or glomerular disease associated to HIV. This review will cover the main aspects of kidney failure associated with HIV.

RESUMO O panorama da infecção pelo vírus da imunodeficiência humana (HIV) vem sofrendo alterações nos últimos anos, tanto em relação ao entendimento da infecção pelo HIV quanto aos tratamentos disponíveis. Como resultado, a doença, que antes estava associada a alta morbimortalidade, é agora considerada uma doença crônica que pode ser controlada, tanto em relação à transmissão quanto aos sintomas. No entanto, mesmo quando a replicação viral é bem controlada, o paciente infectado tem um alto risco de desenvolver complicações renais, seja através de lesão renal aguda não relacionada ao HIV, por nefrotoxicidade causada por drogas antirretrovirais, por doenças crônicas associadas com o aumento da sobrevida ou por doença glomerular associada ao HIV. Esta revisão abordará os principais aspectos da insuficiência renal associada ao HIV.

Evolución de un paciente infectado por el VIH-SIDA en hemodiálisis: experiencia en el centro asistencial / Evolution of a patientinfected by VIH-SIDA in hemodialysis: experience in the assistencial center

La afectación renal en el SIDA es un tema poco abordado a pesar de su frecuencia, la misma depende de la acción directa e indirecta del virus, así como de las complicaciones y del tratamiento. La más frecuente de las complicaciones es la Insuficiencia Renal Aguda. La forma más típica de nefropatía asociada al virus de la inmunodeficiencia humana se caracteriza por alto grado de proteinuria con progresión rápida a Insuficiencia Renal Terminal. En el SIDA se presentan diversas formas de glomerulopatías cuya expresión clínica va desde el Síndrome Nefrítico hasta el Síndrome Nefrótico. Se presenta la experiencia de un caso infectado por el VIH-SIDA con 5 años de evolución, en tratamiento hemodialítico donde se mostró una alta morbilidad en el proceder(AU)

Renal involvement in AIDS is an issue not too much spoken In spite of its frequency, this condition depends on direct and indirect virus action, just as the complications and treatment. The most frecuent complication is the acute renal insufficiency. The most typic way of aids-associated nephropathy is characterized by high level of proteinuria with faster progresión to chronic kidney failure. Different forms of glomerulopathies are presented in aids, clinic expression of which goes from nephritic syndrome to nephrotic syndrome. Following an experience case infected by HIV-AIDS with five years progressing in hemodialitic treatment is presented where it showed a high morbidity(AU)

Evolución de un paciente infectado por el VIH-SIDA en hemodiálisis: experiencia en el centro asistencial / Evolution of a patientinfected by VIH-SIDA in hemodialysis: experience in the assistencial center

La afectación renal en el SIDA es un tema poco abordado a pesar de su frecuencia, la misma depende de la acción directa e indirecta del virus, así como de las complicaciones y del tratamiento. La más frecuente de las complicaciones es la Insuficiencia Renal Aguda. La forma más típica de nefropatía asociada al virus de la inmunodeficiencia humana se caracteriza por alto grado de proteinuria con progresión rápida a Insuficiencia Renal Terminal. En el SIDA se presentan diversas formas de glomerulopatías cuya expresión clínica va desde el Síndrome Nefrítico hasta el Síndrome Nefrótico. Se presenta la experiencia de un caso infectado por el VIH-SIDA con 5 años de evolución, en tratamiento hemodialítico donde se mostró una alta morbilidad en el proceder.

Renal involvement in AIDS is an issue not too much spoken In spite of its frequency, this condition depends on direct and indirect virus action, just as the complications and treatment. The most frecuent complication is the acute renal insufficiency. The most typic way of aids-associated nephropathy is characterized by high level of proteinuria with faster progresión to chronic kidney failure. Different forms of glomerulopathies are presented in aids, clinic expression of which goes from nephritic syndrome to nephrotic syndrome. Following an experience case infected by HIV-AIDS with five years progressing in hemodialitic treatment is presented where it showed a high morbidity.

Proteinuria in children infected with the human immunodeficiency virus.

OBJECTIVES: To determine the prevalence of proteinuria in a large cohort of children infected with the human immunodeficiency virus (HIV) and their longitudinal progression during treatment with highly active antiretroviral therapy. STUDY DESIGN: In a retrospective cohort study, 286 children infected with HIV were monitored with quantitative assays of proteinuria from January 1998 through January 2007, with monitoring of viral load, lymphocyte profiles, kidney function, and mortality rates. Proteinuria was quantitated by urine protein to creatinine ratio (Upr/cr). RESULTS: Ninety-four (33%) had proteinuria at baseline. Of these, 32 (11.2%) had nephrotic range proteinuria (Upr/cr > or = 1.0). Initial screening was at 11 +/- 0.3 years of age, with an average follow-up of 5.6 +/- 0.1 years. The mortality rate was significantly greater in those with proteinuria. During the period of observation, 15 patients with nephrotic proteinuria died or had development of end-stage renal disease, and 16 showed improvement. Of those with intermediate range proteinuria (Upr/cr > or = 0.2 < 1.0), 3 progressed to nephrotic range proteinuria, and 39 (63%) showed resolution of the proteinuria (Upr/cr < 0.2). Improvement in proteinuria was correlated with decreasing viral load (r = 0.5; P < .01). CONCLUSIONS: Control of viral load with highly active antiretroviral therapy appears to prevent the progression of HIV-associated renal disease and improve survival rates in infected children.

Compromiso renal en el síndorme de inmunodeficiencia adquirida (SIDA)

Se estudió la función renal en 65 pacientes con SIDA, los factores de riesgo fueron homosexualidad (83 por ciento), transfusión (6.1 por ciento), drogadicción intravenosa (1.5 por ciento) desconocido (9.2 por ciento). En 12 pacientes se practicó biopsia renal percutánea realizándose microscopía de luz (ML) e inmunofluorescencia (IF); se revisó la ML de los cortes de riñon de siete autopsias. La depuración de creatinina osciló entre 48 y 100 ml/min. El 50 por ciento de los pacientes presentó proteinuria inferior a 800 mg en 24 horas, ningún paciente presentó síndrome nefrótico. Los hallazgos en el sedimento urinario fueron hematuria, cilindruria, leucocituria y bacteriuria. la biopsia renal fue normal en 50 por ciento de los casos; se encontró proliferación mesangial en 33 por ciento, esclerosis gomerular en 8 por ciento y nefritis tubulointersticial en 8 por ciento. La IF mostró IgG en el 75 por ciento de las biopsias, fibrinógeno en el 8 por ciento; fue negativa para IgA, IgM y C3. Las autopsias mostrarón proliferación mesangial en 42 por ciento de los casos, nefritis tubulointersticial en 28 por ciento, infección por citomegalovirus en 28 por ciento, por criptococo en 28 por ciento y melanoma metastásico en 14 por ciento de los especímenes