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Shichijo Y, Harada K, Ward SC, Harbord N. Human Immunodeficiency Virus-associated Immune Complex Kidney Disease Progressing to End-stage Kidney Disease. Intern Med 2023; 62:3183-3186. [PMID: 36927969 PMCID: PMC10686720 DOI: 10.2169/internalmedicine.1415-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/06/2023] [Indexed: 03/15/2023] Open
Abstract
A 58-year-old man with human immunodeficiency virus (HIV) infection presented with a week-long history of gross hematuria, nephrotic proteinuria, and acute kidney injury. The patient was non-adherent with combination antiretroviral therapy. A kidney biopsy showed cellular crescents with disruption of Bowman's capsule, C3-dominant immune complex deposition, consistent with HIV-associated immune complex kidney disease (HIVICK). During the course, his worsening kidney function warranted initiation of hemodialysis. This case highlights the fact that HIV patients are at an increased risk of developing HIVICK, especially in the setting of non-adherence. A greater understanding of HIVICK among HIV patients should promote additional investigation into its etiology and viable treatments.
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Affiliation(s)
- Yuka Shichijo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, USA
| | - Ko Harada
- Department of Medicine, Icahn School of Medicine at Mount Sinai, USA
| | - Stephen C Ward
- Department of Pathology, Icahn School of Medicine at Mount Sinai, USA
| | - Nikolas Harbord
- Department of Medicine/Nephrology, Icahn School of Medicine at Mount Sinai, USA
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2
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Casuscelli C, Longhitano E, Maressa V, Di Carlo S, Peritore L, Di Lorenzo S, Calabrese V, Cernaro V, Santoro D. Autoimmunity and Infection in Glomerular Disease. Microorganisms 2023; 11:2227. [PMID: 37764071 PMCID: PMC10538233 DOI: 10.3390/microorganisms11092227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The ongoing glomerular damage of infections is not limited to the most widely known form of post-streptococcal glomerulonephritis, which is today less common in the Western world; other forms of glomerulonephritis are associated with several bacterial, viral and parasitic pathogens. The mechanisms responsible range from the direct damage of glomerular cells to the formation and deposition of immunocomplexes to molecular mimicry to the secretion of superantigens. Similarly, in the course of glomerular disease, infections are more frequent than in the general population due to the loss of immunoglobulins in urine and the immunosuppressive agents used to treat the autoimmune disease that decrease the activity of the immune system. Recognizing this two-way link, understanding its pathogenetic mechanism, and identifying the most appropriate therapeutic choice are essential for the personalized management of patients. In this continuously developing field, this short review summarizes the current state of the art as support for physicians, who are increasingly involved in managing patients with glomerular disease and infections.
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Affiliation(s)
- Chiara Casuscelli
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. “G. Martino”, University of Messina, 98122 Messina, Italy; (E.L.); (V.M.); (S.D.C.); (L.P.); (S.D.L.); (V.C.); (V.C.)
| | | | | | | | | | | | | | | | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. “G. Martino”, University of Messina, 98122 Messina, Italy; (E.L.); (V.M.); (S.D.C.); (L.P.); (S.D.L.); (V.C.); (V.C.)
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3
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Wang JL, Sun YL, Kang Z, Zhang SK, Yu CX, Zhang W, Xie H, Lin HL. Anti-phospholipase A2 receptor-associated membranous nephropathy with human immunodeficiency virus infection treated with telitacicept: A case report. World J Clin Cases 2023; 11:5309-5315. [PMID: 37621578 PMCID: PMC10445080 DOI: 10.12998/wjcc.v11.i22.5309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The co-occurrence of Anti-phospholipase A2 receptor-associated membranous nephropathy (anti-PLA2R-MN) and human immunodeficiency virus (HIV) infection is a rare clinical scenario, presenting significant challenges in terms of management and treatment. CASE SUMMARY A 32-year-old Chinese male diagnosed with HIV infection presented with a clinical history of proteinuria persisting for over two years. A kidney biopsy demonstrated subepithelial immune complex deposition and a thickened glomerular basement membrane, indicative of stage I-II membranous nephropathy. Immunofluorescence staining revealed granular deposition of PLA2R (3+) along the glomerular capillary loops, corroborated by a strongly positive anti-PLA2R antibody test (1:320). Initial treatment involving losartan potassium, rivaroxaban, tacrolimus, and rituximab was discontinued due to either poor effectiveness or the occurrence of adverse events. Following a regimen of weekly subcutaneous injections of telitacicept (160 mg), a marked decline in the 24 h urine protein was observed within a three-month period, accompanied by a rise in serum albumin level. No significant reductions in peripheral blood CD3+CD4+T and CD3+CD8+T cell counts were detected. The patient's physical and psychological conditions showed significant improvements, with no adverse events reported during the treatment course. CONCLUSION Telitacicept might offer a potential therapeutic avenue for patients diagnosed with anti-PLA2R-MN concomitant with HIV infection.
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Affiliation(s)
- Jin-Ling Wang
- Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
| | - Yan-Ling Sun
- Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
| | - Zhe Kang
- Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
| | - Sheng-Kun Zhang
- Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
| | - Chun-Xin Yu
- Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
| | - Wan Zhang
- Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
| | - Hua Xie
- Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
| | - Hong-Li Lin
- Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
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4
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Wearne N, Manning K, Price B, Rayner BL, Davidson B, Jones ESW, Spies R, Cunningham C, Omar A, Ash S, Bohmer R, Kennedy L, Post F. The Evolving Spectrum of Kidney Histology in HIV-Positive Patients in South Africa. Kidney Int Rep 2023; 8:1087-1096. [PMID: 37180521 PMCID: PMC10166739 DOI: 10.1016/j.ekir.2023.02.1076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/24/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Sub-Saharan Africa remains challenged by the highest burden of human immunodeficiency virus (HIV), an epidemic of tuberculosis (TB), and increasing number of people with HIV (PWH) on antiretroviral therapy (ART), all of which may result in kidney injury. Methods This observational cohort study describes the spectrum of kidney disease in PWH in South Africa, between 2005 and 2020. Kidney biopsies were analyzed in 4 time periods as follows: early ART rollout (2005-2009), tenofovir disoproxil (TDF) introduction (2010-2012), TDF-based fixed dose combination (2013-2015), and ART at HIV diagnosis (2016-2020). Logistic regression was used to identify factors associated with HIV-associated nephropathy or focal segmental glomerulosclerosis (HIVAN/FSGS) and tubulointerstitial disease (TID). Results We included 671 participants (median age 36, interquartile range, 21-44 years; 49% female; median CD4 cell count 162 [interquartile range, 63-345] cells/mm3). Over time, ART (31%-65%, P < 0.001), rate of HIV suppression (20%-43%, P < 0.001), nonelective biopsies (53%-72%, P < 0.001), and creatinine at biopsy (242-449 μmol/l, P < 0.001) increased. A decrease in HIVAN (45%-29% P < 0.001) was accompanied by an increase in TID (13%-33%, P < 0.001). Granulomatous interstitial nephritis accounted for 48% of TID, mostly because of TB. Exposure to TDF was strongly associated with TID (adjusted odds ratio 2.99, 95% confidence interval 1.89-4.73 P < 0.001). Conclusion As ART programs intensified and increasingly used TDF, the spectrum of kidney histology in PWH evolved from a predominance of HIVAN in the early ART era to TID in recent times. The increase in TID is likely due to multiple exposures that include TB, sepsis, and TDF as well as other insults.
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Affiliation(s)
- Nicola Wearne
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Kathryn Manning
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Brendon Price
- Division of Anatomical, Department of Pathology, National Health Laboratory Service and University of Cape Town, Cape Town, South Africa
| | - Brian L. Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Bianca Davidson
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Erika SW Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Ruan Spies
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Carol Cunningham
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Aadil Omar
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Samantha Ash
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Raphaela Bohmer
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Luca Kennedy
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Frank Post
- Department of HIV Medicine, Kings College Hospital NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, King’s College London, London, UK
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Hung RKY, Winkler CA, Post FA. Host factors predisposing to kidney disease in people with HIV. Curr Opin HIV AIDS 2023; 18:87-92. [PMID: 36722197 DOI: 10.1097/coh.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To highlight advances in understanding of host factors, in particular host genetics, in the development of chronic kidney disease (CKD) in people with HIV. RECENT FINDINGS In Black populations, the G1 and G2 variants of the apolipoprotein L1 (APOL1) gene predispose to HIV-associated nephropathy (HIVAN). The risk of HIVAN is mostly confined to individuals with two APOL1 variants (kidney-risk genotypes). APOL1 kidney-risk genotypes are present in approximately 80% of patients with HIVAN and account for nearly half the burden of end-stage CKD in people of African ancestry with HIV. Progress has been made in elucidating the mechanisms of kidney injury in APOL1 nephropathy, and several targeted molecular therapies are being investigated in clinical trials. Genome- and epigenome-wide association studies are identifying additional genes and pathways that may be involved in the pathogenesis of CKD in people with HIV. SUMMARY Genetic variants of APOL1 are strongly associated with severe CKD and contribute to the high rates of CKD in Black populations with HIV. Most individuals with APOL1 kidney-risk genotypes, however, do not develop kidney disease and further studies are required to understand the role of additional genetic and environmental factors that may affect CKD risk in this population.
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Affiliation(s)
| | - Cheryl A Winkler
- Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA
| | - Frank A Post
- King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
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6
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Treatment of HIV-Associated Lupus-like Membranous Nephropathy with Tacrolimus: A Case Report and Review of the Literature. Life (Basel) 2023; 13:life13030641. [PMID: 36983799 PMCID: PMC10053887 DOI: 10.3390/life13030641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Renal complications of HIV infection are common and histologically diverse. Besides HIV-associated nephropathy, which is the most well-defined glomerular disorder, immune-complex-mediated glomerulonephritis (HIVICK) is also encountered in the setting of HIV infection and may occasionally present with “lupus-like” features by light microscopy and immunofluorescence. Management of HIVICK remains controversial and mainly focuses on HIV viremia suppression with combined antiretroviral therapy. Immunosuppressive therapy may be used in order to mitigate the renal inflammation induced by the immune complex deposition. Data regarding the use of immunosuppressants in HIVICK are very limited, mostly including corticosteroids and mycophenolate acid analogues. Herein, we present the case of a 40-year-old HIV-infected Caucasian man with nephrotic syndrome, renal impairment, and a “lupus-like” membranous pattern in the kidney biopsy, who achieved a partial response of his proteinuria with a tacrolimus-based regimen in combination with antiretroviral therapy.
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7
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Tenofovir disoproxil and renal mitochondrial toxicity: more studies in Africans are needed. AIDS 2022; 36:1047-1048. [PMID: 35652676 DOI: 10.1097/qad.0000000000003219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Turner D, Drak D, Gracey D, Anderson L. Patterns of biopsy-proven renal disease in people living with HIV: 10 years experience in Sydney, Australia. BMC Nephrol 2022; 23:148. [PMID: 35430806 PMCID: PMC9014572 DOI: 10.1186/s12882-022-02695-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Acute and chronic kidney diseases are important comorbidities in People Living With HIV (PLWH). Biopsy is often pursued in this cohort with ongoing renal impairment without a clear aetiology, in order to establish the diagnosis and to guide management. Despite the importance of renal disease in PLWH, there is a paucity of biopsy data—especially in the Australian setting. Consequently, who and when to biopsy is mainly based on clinical experience. The aims of this study were to describe biopsy-proven renal disease in PLWH at our institution and to assess for correlation between any demographic or laboratory characteristics with histological diagnosis. Methods A retrospective review of all PLWH who underwent renal biopsy between January 2010 and December 2020 at Royal Prince Alfred Hospital, Sydney, Australia was performed. All PLWH over 18 years, who were not transplant recipients were included. Demographic, laboratory and biopsy data was extracted from the electronic medical records. Basic descriptive statistics were performed, and correlation was assessed using chi square and Kendall’s coefficient of rank test. Results 19 renal biopsies were included in the study. The majority of PLWH were Australian born (53%), male (84%) and had a mean age of 48 years (SD 13). Comorbid hypertension and diabetes were present in 74% and 21% of people respectively. The mean serum creatinine was 132 µmol/L (SD 55) and the mean estimated glomerular filtration rate (eGFR) was 61 ml/min/1.73m2 (SD 24). The most common histological diagnosis was tubulointerstial nephritis in 5 people (24%). Hypertensive glomerulosclerosis and IgA nephropathy were present in 4 (19%) and 3 (14%) people respectively. There were no cases of HIV-associated nephropathy. There was no significant correlation between any cohort characteristics and diagnoses. Conclusions This study represents the first description of biopsy-proven kidney disease in the HIV-infected population of Australia. Our results support the use of renal biopsy in PLWH with ongoing renal impairment for accurate diagnosis and to guide further management. Although a small sample size, our study is larger than other published international biopsy studies.
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Affiliation(s)
- Dane Turner
- Department of Nephrology, Royal Prince Alfred Hospital, 50 Misseden Road Camperdown, Sydney, NSW, Australia. .,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Doug Drak
- Department of Nephrology, Royal Prince Alfred Hospital, 50 Misseden Road Camperdown, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David Gracey
- Department of Nephrology, Royal Prince Alfred Hospital, 50 Misseden Road Camperdown, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lyndal Anderson
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Hung RK, Binns-Roemer E, Booth JW, Hilton R, Harber M, Santana-Suarez B, Campbell L, Fox J, Ustianowski A, Cosgrove C, Burns JE, Clarke A, Price DA, Chadwick D, Onyango D, Hamzah L, Bramham K, Sabin CA, Winkler CA, Post FA. Genetic Variants of APOL1 Are Major Determinants of Kidney Failure in People of African Ancestry With HIV. Kidney Int Rep 2022; 7:786-796. [PMID: 35497797 PMCID: PMC9039486 DOI: 10.1016/j.ekir.2022.01.1054] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction Variants of the APOL1 gene are associated with chronic kidney disease (CKD) in people of African ancestry, although evidence for their impact in people with HIV are sparse. Methods We conducted a cross-sectional study investigating the association between APOL1 renal risk alleles and kidney disease in people of African ancestry with HIV in the UK. The primary outcome was end-stage kidney disease (ESKD; estimated glomerular filtration rate [eGFR] of <15 ml/min per 1.73 m2, chronic dialysis, or having received a kidney transplant). The secondary outcomes included renal impairment (eGFR <60 ml/min per 1.73 m2), albuminuria (albumin-to-creatinine ratio [ACR] >30 mg/mmol), and biopsy-proven HIV-associated nephropathy (HIVAN). Multivariable logistic regression was used to estimate the associations between APOL1 high-risk genotypes (G1/G1, G1/G2, G2/G2) and kidney disease outcomes. Results A total of 2864 participants (mean age 48.1 [SD 10.3], 57.3% female) were genotyped, of whom, 354 (12.4%) had APOL1 high-risk genotypes, and 99 (3.5%) had ESKD. After adjusting for demographic, HIV, and renal risk factors, individuals with APOL1 high-risk genotypes were at increased odds of ESKD (odds ratio [OR] 10.58, 95% CI 6.22-17.99), renal impairment (OR 5.50, 95% CI 3.81-7.95), albuminuria (OR 3.34, 95% CI 2.00-5.56), and HIVAN (OR 30.16, 95% CI 12.48-72.88). An estimated 49% of ESKD was attributable to APOL1 high-risk genotypes. Conclusion APOL1 high-risk genotypes were strongly associated with kidney disease in people of African ancestry with HIV and accounted for approximately half of ESKD cases in this cohort.
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Affiliation(s)
| | - Elizabeth Binns-Roemer
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, Maryland, USA
| | | | - Rachel Hilton
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Mark Harber
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | | | | | - Julie Fox
- King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | | | - James E. Burns
- University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Brighton and Sussex University Hospital NHS Trust, Brighton, UK
- Brighton and Sussex Medical School Department of Infectious Disease, Brighton, UK
| | | | - David Chadwick
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Lisa Hamzah
- St George’s Hospital NHS Foundation Trust, London, UK
| | - Kate Bramham
- King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Cheryl A. Winkler
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, Maryland, USA
| | - Frank A. Post
- King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
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Lavine N, Ohayon A, Mahroum N. Renal autoimmunity: The role of bacterial and viral infections, an extensive review. Autoimmun Rev 2022; 21:103073. [PMID: 35245692 DOI: 10.1016/j.autrev.2022.103073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 02/27/2022] [Indexed: 02/08/2023]
Abstract
Autoimmunity is a process by which the loss of self-tolerance results in an immune attack against the body own tissues and organs. For autoimmunity to occur, various elements serving as triggers were described by which infections are considered one of the leading factors. In turn, renal involvement in autoimmune diseases, whether by an organ-specific attack, or as part of a systemic disease process, is well known. As bacterial and viral infections are considered to be common triggers for autoimmunity in general, we aimed to study their association with renal autoimmunity in particular. We performed an extensive search of the recent and relevant medical literature regarding renal autoimmunity syndromes such as infection-associated glomerulonephritis and vasculitis, associated with bacterial and viral infections. By utilizing PubMed and Google Scholar search engines, over 200 articles and case reports were reviewed. Among other mechanisms, direct infection of the renal parenchyma, molecular mimicry, induction of B-cells or secretion of superantigens, bacterial and viral pathogens were found to correlate with the development of renal autoimmunity. Nevertheless, this was not true for all pathogens, as some mimic autoimmune diseases and others show a surprisingly protective effect. The exact immunopathogenesis is yet to be determined, however. For conclusion, bacterial and viral infections are linked to renal autoimmunity by both direct damage and as mediators of systemic diseases. Further research particularly on the immunopathogenetic mechanisms of renal autoimmunity associated with infections is required.
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Affiliation(s)
- Noy Lavine
- St. George School of Medicine, University of London, London, UK; Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel.
| | - Aviran Ohayon
- St. George School of Medicine, University of London, London, UK; Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Naim Mahroum
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel; International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Hung RK, Binns-Roemer E, Booth JW, Hilton R, Fox J, Burns F, Harber M, Ustianowski A, Hamzah L, Burns JE, Clarke A, Price DA, Kegg S, Onyango D, Santana-Suarez B, Campbell L, Bramham K, Sharpe CC, Sabin CA, Winkler CA, Post FA. Sickle Cell Trait and Kidney Disease in People of African Ancestry With HIV. Kidney Int Rep 2022; 7:465-473. [PMID: 35257059 PMCID: PMC8897676 DOI: 10.1016/j.ekir.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Sickle cell trait (SCT) has been associated with chronic kidney disease (CKD) in African Americans, although evidence for its impact in Africans and people with HIV is currently lacking. We conducted a cross-sectional study investigating the association between SCT and kidney disease in people of African ancestry with HIV in the UK. Methods The primary outcome was estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. Secondary outcomes were eGFR <90 ml/min per 1.73 m2, end-stage kidney disease (ESKD; eGFR <15 ml/min per 1.73 m2, chronic dialysis, or having received a kidney transplant), proteinuria (protein-to-creatinine ratio >50 mg/mmol), and albuminuria (albumin-to-creatinine ratio >3 mg/mmol). Multivariable logistic regression was used to estimate the associations between SCT and kidney disease outcomes. Results A total of 2895 participants (mean age 48.1 [SD 10.3], 57.2% female) were included, of whom 335 (11.6%) had SCT and 352 (12.2%) had eGFR <60 ml/min per 1.73 m2. After adjusting for demographic, HIV, and kidney risk factors including APOL1 high-risk genotype status, individuals with SCT were more likely to have eGFR <60 ml/min per 1.73 m2 (odds ratio 1.62 [95% CI 1.14-2.32]), eGFR <90 ml/min per 1.73 m2 (1.50 [1.14-1.97]), and albuminuria (1.50 [1.09-2.05]). Stratified by APOL1 status, significant associations between SCT and GFR <60 ml/min per 1.73 m2, eGFR <90 ml/min per 1.73 m2, proteinuria, and albuminuria were observed for those with APOL1 low-risk genotypes. Conclusion Our results extend previously reported associations between SCT and kidney disease to people with HIV. In people of African ancestry with HIV, these associations were largely restricted to those with APOL1 low-risk genotypes.
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Affiliation(s)
| | - Elizabeth Binns-Roemer
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, Maryland, USA
| | | | - Rachel Hilton
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Julie Fox
- King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Fiona Burns
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | - Mark Harber
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | | | - Lisa Hamzah
- St George’s Hospital NHS Foundation Trust, London, UK
| | - James E. Burns
- University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Brighton and Sussex University Hospital NHS Trust, Brighton, UK
- Department of Infectious Disease, Brighton and Sussex Medical School, Brighton, UK
| | | | | | | | | | | | - Kate Bramham
- King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Claire C. Sharpe
- King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Cheryl A. Winkler
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, Maryland, USA
| | - Frank A. Post
- King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
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12
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Luciani LG, Mattevi D. Urinary Tract Infections: Virus. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8357242 DOI: 10.1016/b978-0-12-818731-9.00139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Although viruses are common in the urinary tract in healthy people, viral infections can become a major concern in immunocompromised individuals. Patients undergoing hematopoietic stem cell or solid organ transplantation may be particularly susceptible to BK and other viruses, and experience a high risk of mortality. The most common presentation in this setting is hemorrhagic cystitis. The treatment is mostly supportive, including the reduction of immunosuppression; a variety of experimental agents has also been proposed. A different context is offered by chronic (HBV, HCV, HIV) or acute/subacute (Dengue, Hantavirus, etc.) infections, where the kidneys can be secondarily involved and suffer from several glomerular syndromes. Many protocols based on different oral direct-acting antivirals and combined antiretrovirals are available, according to the systemic infection. Viral infections can be classified according to the organ involved, i.e. lower (bladder) or upper urinary tract (kidneys, ureters), and to the mechanism of injury. A section is dedicated to the current breakout of SARS-CoV-2, which does not spare the urinary tract, sometimes with serious implications. Even if this topic is mostly the discipline of ultra-dedicated physicians, this overview has a practical approach and could be useful to a wider medical audience, especially in times of viral pandemics.
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13
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Adnani H, Agrawal N, Khatri A, Vialet J, Zhang M, Cervia J. Impact of Antiretroviral Therapy on Kidney Disease in HIV Infected Individuals - A Qualitative Systematic Review. J Int Assoc Provid AIDS Care 2022; 21:23259582221089194. [PMID: 35369795 PMCID: PMC8984856 DOI: 10.1177/23259582221089194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Kidney disease is the fourth most common cause of non-AIDS-related mortality in
people living with HIV. Combination antiretroviral therapy (cART) remains the
cornerstone of treatment. However, little is known about the impact of cART on
disease outcomes in patients with HIV-associated nephropathy (HIVAN) and
HIV-immune complex kidney disease (HIVICK). This systematic review evaluates the
impact of cART on progression to end-stage kidney disease (ESKD) and other
outcomes in HIV-infected individuals. We conducted a literature search utilizing
PubMed, and Cochrane database and 11 articles met inclusion criteria for
analysis of which nine HIVAN studies showed decreased progression to ESKD or
death for subjects when treated with cART versus those untreated. However, two
studies showed no survival advantage with cART. Three HIVICK studies showed
improvement in delaying ESKD in subjects on cART compared to untreated subjects.
cART appeared to reduce the risk to ESKD or death in patients with both HIVAN
and HIVICK.
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Affiliation(s)
- Harsha Adnani
- 490225Anne Arundel Medical Center, Annapolis, Maryland, USA
| | - Nirav Agrawal
- 88982Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Akshay Khatri
- Division of Infectious Diseases, Department of Medicine, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jaclyn Vialet
- North Shore University Hospital, Clinical Medical Library, Manhasset, New York, USA
| | - Meng Zhang
- 88982Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Joseph Cervia
- Division of Infectious Diseases, Department of Medicine, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,24945North Shore University Hospital, Manhasset, New York, USA.,232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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14
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Muiru AN, Madden E, Chilingirian A, Rubinsky AD, Scherzer R, Moore R, Villalobos CPC, Monroy Trujillo JM, Parikh CR, Hsu CY, Shlipak MG, Estrella MM. The incidence of and risk factors for hospitalized acute kidney injury among people living with HIV on antiretroviral treatment. HIV Med 2021; 23:611-619. [PMID: 34897925 DOI: 10.1111/hiv.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The epidemiology of hospitalized acute kidney injury (AKI) among people living with HIV (PLWH) in the era of modern antiretroviral therapy (ART) for all PLWH is not well characterized. We evaluated the incidence of and risk factors for hospitalized AKI from 2005 to 2015 among PLWH on ART. METHODS We conducted a retrospective analysis of PLWH from the Johns Hopkins HIV Clinical Cohort. We defined hospitalized AKI as a rise of ≥ 0.3 mg/dL in serum creatinine (SCr) within any 48-h period or a 50% increase in SCr from baseline and assessed associations of risk factors with incident AKI using multivariate Cox regression models. RESULTS Most participants (75%) were black, 34% were female, and the mean age was 43 years. The incidence of AKI fluctuated annually, peaking at 40 per 1000 person-years (PY) [95% confidence interval (CI) 22-69 per 1000 PY] in 2007, and reached a nadir of 20 per 1000 PY (95% CI 11-34 per 1000 PY) in 2010. There was no significant temporal trend (-3.3% change per year; 95% CI -8.6 to 2.3%; P = 0.24). After multivariable adjustment, characteristics independently associated with AKI included black race [hazard ratio (HR) 2.44; 95% CI 1.42-4.20], hypertension (HR 1.62; 95% CI 1.09-2.38), dipstick proteinuria > 1 (HR 1.86; 95% CI 1.07-3.23), a history of AIDS (HR 1.82; 95% CI 1.29-2.56), CD4 count < 200 cells/µL (HR 1.46; 95% CI 1.02-2.07), and lower serum albumin (HR 1.73 per 1 g/dL decrease; 95% CI 1.02-2.07). CONCLUSIONS In this contemporary cohort of PLWH, the annual incidence of first AKI fluctuated during the study period. Attention to modifiable AKI risk factors and social determinants of health may further reduce AKI incidence among PLWH.
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Affiliation(s)
- Anthony N Muiru
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA.,Division of Nephrology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Erin Madden
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco VA Health Care System, San Francisco, CA, USA
| | - Ani Chilingirian
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA
| | - Anna D Rubinsky
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco VA Health Care System, San Francisco, CA, USA
| | - Richard Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Chirag R Parikh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco VA Health Care System, San Francisco, CA, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA.,Division of Nephrology, Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco VA Health Care System, San Francisco, CA, USA
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15
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Caza TN, Al-Rabadi LF, Beck LH. How Times Have Changed! A Cornucopia of Antigens for Membranous Nephropathy. Front Immunol 2021; 12:800242. [PMID: 34899763 PMCID: PMC8662735 DOI: 10.3389/fimmu.2021.800242] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
The identification of the major target antigen phospholipase A2 receptor (PLA2R) in the majority of primary (idiopathic) cases of membranous nephropathy (MN) has been followed by the rapid identification of numerous minor antigens that appear to define phenotypically distinct forms of disease. This article serves to review all the known antigens that have been shown to localize to subepithelial deposits in MN, as well as the distinctive characteristics associated with each subtype of MN. We will also shed light on the novel proteomic approaches that have allowed identification of the most recent antigens. The paradigm of an antigen normally expressed on the podocyte cell surface leading to in-situ immune complex formation, complement activation, and subsequent podocyte injury will be discussed and challenged in light of the current repertoire of multiple MN antigens. Since disease phenotypes associated with each individual target antigens can often blur the distinction between primary and secondary disease, we encourage the use of antigen-based classification of membranous nephropathy.
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Affiliation(s)
| | - Laith F. Al-Rabadi
- Department of Internal Medicine (Nephrology & Hypertension), University of Utah, Salt Lake City, UT, United States
| | - Laurence H. Beck
- Department of Medicine (Nephrology), Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
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16
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Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, Cook HT, Fervenza FC, Gibson KL, Glassock RJ, Jayne DR, Jha V, Liew A, Liu ZH, Mejía-Vilet JM, Nester CM, Radhakrishnan J, Rave EM, Reich HN, Ronco P, Sanders JSF, Sethi S, Suzuki Y, Tang SC, Tesar V, Vivarelli M, Wetzels JF, Floege J. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021; 100:S1-S276. [PMID: 34556256 DOI: 10.1016/j.kint.2021.05.021] [Citation(s) in RCA: 657] [Impact Index Per Article: 219.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022]
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17
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Balozian P, Al Armashi AR, Haidous M, Cruz-Peralta M, Ravakhah K. A Case of Focal Segmental Glomerulosclerosis With Immune Complexes: Is HIV, Hepatitis B, or Crack the Culprit? Cureus 2021; 13:e17335. [PMID: 34557371 PMCID: PMC8450022 DOI: 10.7759/cureus.17335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/09/2022] Open
Abstract
Human immunodeficiency virus (HIV)-positive individuals are at an increased risk for kidney diseases, including HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS), HIV immune complex disease of the kidney (HIVICK), and acute tubular necrosis (ATN). Non-modifiable factors such as age and genetics, as well as modifiable factors such as illicit drug use and compliance, define the progression to renal failure. The patient is a 64-year-old African American male with HIV, treated latent syphilis, chronic kidney disease stage 3a, and cocaine use disorder who presented with shortness of breath, bilateral lower extremities swelling, and fatigue with normal vitals and a physical exam remarkable for bibasilar inspiratory crackles with peripheral edema. Laboratory tests showed creatinine (Cr) of 2.23 mg/dL with a baseline of 1.5 mg/dL, albumin of 1.8, blood natriuretic peptide (BNP) of 667.88, and lipidemia. His urine was remarkable for proteinuria and microalbuminuria in the presence of cocaine. Immunofixation electrophoresis showed a marked increase in IgG and IgM, free lambda, and free kappa/free lambda ratio with HIV viral load of 39,400 copies/ml, absolute CD4 count of 56, and an acute hepatitis B panel. Renal biopsy confirmed HIVAN with FSGS accompanied by collapsing features, HIVICK, and ATN. The patient was subsequently started on highly active antiretroviral therapy (HAART) with prophylactic antibiotics and close monitoring.
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Affiliation(s)
- Patil Balozian
- Internal Medicine, St. Vincent Charity Medical Center, Cleveland, USA
| | | | - Mohammad Haidous
- Internal Medicine, St. Vincent Charity Medical Center, Cleveland, USA
| | | | - Keyvan Ravakhah
- Internal Medicine, St. Vincent Charity Medical Center, Cleveland, USA
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18
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Hung RK, Santana-Suarez B, Binns-Roemer E, Campbell L, Bramham K, Hamzah L, Fox J, Burns JE, Clarke A, Vincent R, Jones R, Price DA, Onyango D, Harber M, Hilton R, Booth JW, Sabin CA, Winkler CA, Post FA. The epidemiology of kidney disease in people of African ancestry with HIV in the UK. EClinicalMedicine 2021; 38:101006. [PMID: 34286237 PMCID: PMC8273351 DOI: 10.1016/j.eclinm.2021.101006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a leading cause of morbidity and mortality globally. The risk of CKD is increased in people of African ancestry and with Human Immunodeficiency Virus (HIV) infection. METHODS We conducted a cross-sectional study investigating the relationship between region of ancestry (East, Central, South or West Africa) and kidney disease in people of sub-Saharan African ancestry with HIV in the UK between May 2018 and February 2020. The primary outcome was renal impairment (estimated glomerular filtration rate [eGFR] of <60 mL/min/1.73 m2). Secondary outcomes were stage 5 CKD (eGFR <15 ml/min/1.73 m2, on dialysis for over 3 months or who had received a kidney transplant), proteinuria (urine protein/creatinine ratio >50 mg/mmol), and biopsy-confirmed HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS) or arterionephrosclerosis. Multivariable robust Poisson regression estimated the effect of region of African ancestry on kidney disease outcomes. FINDINGS Of the 2468 participants (mean age 48.1 [SD 9.8] years, 62% female), 193 had renal impairment, 87 stage 5 CKD, 126 proteinuria, and 43 HIVAN/FSGS or arterionephrosclerosis. After adjusting for demographic characteristics, HIV and several CKD risk factors and with East African ancestry as referent, West African ancestry was associated with renal impairment (prevalence ratio [PR] 2.06 [95% CI 1.40-3.04]) and stage 5 CKD (PR 2.23 [1.23-4.04]), but not with proteinuria (PR 1.27 [0.78-2.05]). West African ancestry (as compared to East/South African ancestry) was also strongly associated with a diagnosis of HIVAN/FSGS or arterionephrosclerosis on kidney biopsy (PR 6.44 [2.42-17.14]). INTERPRETATION Our results indicate that people of West African ancestry with HIV are at increased risk of kidney disease. Although we cannot rule out the possibility of residual confounding, geographical region of origin appears to be a strong independent risk factor for CKD as the association did not appear to be explained by several demographic, HIV or renal risk factors.
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Affiliation(s)
- Rachel K.Y. Hung
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
| | - Beatriz Santana-Suarez
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
| | - Elizabeth Binns-Roemer
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA
| | - Lucy Campbell
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
| | - Kate Bramham
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Hamzah
- St George's Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - James E. Burns
- University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Brighton and Sussex University Hospital NHS Trust, Brighton, UK
- Brighton and Sussex Medical School Department of Infectious Disease, Brighton, UK
| | - Rachel Vincent
- North Middlesex University Hospital NHS Trust, London, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Trust, London, UK
| | | | | | - Mark Harber
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | - Rachel Hilton
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | | | | | - Cheryl A. Winkler
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA
| | - Frank A. Post
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - GEN-AFRICA study group
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA
- King's College Hospital NHS Foundation Trust, London, UK
- St George's Hospital NHS Foundation Trust, London, UK
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
- University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
- Brighton and Sussex University Hospital NHS Trust, Brighton, UK
- Brighton and Sussex Medical School Department of Infectious Disease, Brighton, UK
- North Middlesex University Hospital NHS Trust, London, UK
- Chelsea and Westminster Hospital NHS Trust, London, UK
- The Newcastle Upon Tyne Hospitals, Newcastle, UK
- Africa Advocacy Foundation, UK
- Royal Free London Hospital NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
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19
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Meyer N, Cooper W, Kirwan P, Garsia R, Dunkley S, Gracey DM. Primary membranous glomerulonephritis with negative serum PLA2R in haemophilia A successfully managed with rituximab - case report and review of the literature. BMC Nephrol 2021; 22:268. [PMID: 34294065 PMCID: PMC8299630 DOI: 10.1186/s12882-021-02475-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) cause a wide range of glomerular pathologies. In people with haemophilia, transfusion-associated infections with these viruses are common and definitive pathological diagnosis in this population is complicated by the difficulty of safely obtaining a renal biopsy. Membranous nephropathy (MN) is a common cause of adult onset nephrotic syndrome occurring in both primary and secondary forms. Primary MN is associated with podocyte autoantibodies, predominantly against phospholipase A2 receptor (PLA2R). Secondary disease is often associated with viral infection; however, infrequently with HIV or HCV. Distinguishing these entities from each other and other viral glomerular disease is vital as treatment strategies are disparate. CASE PRESENTATION We present the case of a 48-year-old man with moderate haemophilia A and well-controlled transfusion-associated HCV and HIV coinfection who presented with sudden onset nephrotic range proteinuria. Renal biopsy demonstrated grade two membranous nephropathy with associated negative serum PLA2R testing. Light and electron microscopic appearances were indeterminant of a primary or secondary cause. Given his extremely stable co-morbidities, treatment with rituximab and subsequent angiotensin receptor blockade was initiated for suspected primary MN and the patient had sustained resolution in proteinuria over the following 18 months. Subsequent testing demonstrated PLA2R positive glomerular immunohistochemistry despite multiple negative serum results. CONCLUSIONS Pursuing histological diagnosis is important in complex cases of MN as the treatment strategies between primary and secondary vary significantly. Serum PLA2R testing alone may be insufficient in the presence of multiple potential causes of secondary MN.
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Affiliation(s)
- Nicholas Meyer
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Wendy Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Paul Kirwan
- Electron Microscopy Unit, Department of Anatomical Pathology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Roger Garsia
- Department of Immunology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Scott Dunkley
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - David M Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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20
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Pramod S, Kheetan M, Ogu I, Alsanani A, Khitan Z. Viral Nephropathies, Adding SARS-CoV-2 to the List. Int J Nephrol Renovasc Dis 2021; 14:157-164. [PMID: 34113150 PMCID: PMC8184250 DOI: 10.2147/ijnrd.s303080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Viral infections in the immunocompetent host can cause both acute and chronic kidney disease either as a direct damage to the infected kidney cells or as a consequence of systemic immune responses that impact kidney function. Since identifying these entities in the 1970s and 80s, major breakthroughs in the understanding of the viral mechanisms have occurred. Viruses have evolved mechanisms to hijack signaling pathways of infected cells to evade antiviral immune responses by the host. Over time, the clinical presentations and management of these diseases have evolved along with our in-depth understanding of the various pathophysiological mechanisms causing these conditions. Similarly, both at the cellular and systemic levels, the host has evolved mechanisms to counter viral subversion strategies for mutual survival. Since the start of the current COVID-19 pandemic, numerous cases of acute kidney injury have been reported in the literature with various possible pathophysiological mechanisms. In this review, we summarize lessons learned from prior viral pandemics related to viral mechanisms utilized in the pathogenesis of numerous renal manifestations to attempt to utilize this knowledge in predicting post-COVID-19 kidney disease.
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Affiliation(s)
- Sheena Pramod
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Murad Kheetan
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Iheanyichukwu Ogu
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Ahlim Alsanani
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Zeid Khitan
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
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21
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Tariq A, Kim H, Abbas H, Lucas GM, Atta MG. Pharmacotherapeutic options for kidney disease in HIV positive patients. Expert Opin Pharmacother 2020; 22:69-82. [PMID: 32955946 DOI: 10.1080/14656566.2020.1817383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Since the developmentof combined antiretroviral therapy (cART), HIV-associated mortality and the incidence of HIV-associated end-stage kidney disease (ESKD) has decreased. However, in the United States, an increase in non-HIV-associated kidney diseases within the HIV-positive population is expected. AREAS COVERED In this review, the authors highlight the risk factors for kidney disease within an HIV-positive population and provide the current recommendations for risk stratification and for the monitoring of its progression to chronic kidney disease (CKD), as well as, treatment. The article is based on literature searches using PubMed, Medline and SCOPUS. EXPERT OPINION The authors recommend clinicians (1) be aware of early cART initiation to prevent and treat HIV-associated kidney diseases, (2) be aware of cART side effects and discriminate those that may become more nephrotoxic than others and require dose-adjustment in the setting of eGFR ≤ 30ml/min/1.73m2, (3) follow KDIGO guidelines regarding screening and monitoring for CKD with a multidisciplinary team of health professionals, (4) manage other co-infections and comorbidities, (5) consider changing cART if drug induced toxicity is established with apparent eGFR decline of ≥ 10ml/min/1.73m2 or rising creatinine (≥0.5mg/dl) during drug-drug interactions, and (6) strongly consider kidney transplant in appropriately selected individuals with end stage kidney failure.
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Affiliation(s)
- Anam Tariq
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Hannah Kim
- Division of Pediatric Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Hashim Abbas
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Gregory M Lucas
- Division of Infectious Disease, Johns Hopkins University , Baltimore, MD, US
| | - Mohamed G Atta
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
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22
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Charu V, Andeen N, Walavalkar V, Lapasia J, Kim JY, Lin A, Sibley R, Higgins J, Troxell M, Kambham N. Membranous nephropathy in patients with HIV: a report of 11 cases. BMC Nephrol 2020; 21:401. [PMID: 32948130 PMCID: PMC7501617 DOI: 10.1186/s12882-020-02042-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 08/23/2020] [Indexed: 01/26/2023] Open
Abstract
Background Membranous nephropathy (MN) has been recognized to occur in patients with human immunodeficiency virus (HIV) infection since the beginning of the HIV epidemic. The prevalence of phospholipase A2 receptor (PLA2R)-associated MN in this group has not been well studied. Methods We conducted a retrospective review of electronic pathology databases at three institutions to identify patients with MN and known HIV at the time of renal biopsy. Patients with comorbidities and coinfections known to be independently associated with MN were excluded. Results We identified 11 HIV-positive patients with biopsy-confirmed MN meeting inclusion and exclusion criteria. Patient ages ranged from 39 to 66 years old, and 10 of 11 patients (91%) were male. The majority of patients presented with nephrotic-range proteinuria, were on anti-retroviral therapy at the time of biopsy and had low or undetectable HIV viral loads. Biopsies from 5 of 10 (50%) patients demonstrated capillary wall staining for PLA2R. Measurement of serum anti-PLA2R antibodies was performed in three patients, one of whom had positive anti-PLA2R antibody titers. Follow-up data was available on 10 of 11 patients (median length of follow-up: 44 months; range: 4–145 months). All patients were maintained on anti-retroviral therapy (ARV) and 5 patients (52%) received concomitant immunosuppressive regimens. Three patients developed end-stage renal disease (ESRD) during the follow-up period. Conclusions MN in the setting of HIV is often identified in the setting of an undetectable viral loads, and similar to other chronic viral infection-associated MNs, ~ 50% of cases demonstrate tissue reactivity with PLA2R antigen, which may be seen without corresponding anti-PLA2R serum antibodies.
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Affiliation(s)
- Vivek Charu
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA.
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Vighnesh Walavalkar
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Jessica Lapasia
- Department of Nephrology, The Permanente Medical Group, San Francisco, CA, USA
| | - Jin-Yon Kim
- Department of Nephrology, The Permanente Medical Group, Sacramento, CA, USA
| | - Andrew Lin
- Department of Nephrology, The Permanente Medical Group, San Francisco, CA, USA
| | - Richard Sibley
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - John Higgins
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - Megan Troxell
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
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Tiong M, Wilson S, Pham A, Chrysostomou A. Successful treatment of HIV-associated lupus-like glomerulonephritis with mycophenolic acid. Clin Case Rep 2020; 8:1601-1604. [PMID: 32983458 PMCID: PMC7495868 DOI: 10.1002/ccr3.2955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/12/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022] Open
Abstract
HIV-associated lupus-like glomerulonephritis is an uncommon but well-described entity. Treatment has traditionally focused on control of HIV viremia with some using adjuvant steroids. Mycophenolic acid may prove to be a novel, nonsteroid, therapy in patients with active glomerulonephritis despite control of the underlying infection.
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Affiliation(s)
- Mark Tiong
- Department of Renal MedicineAlfred HealthMelbourneVic.Australia
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVic.Australia
| | - Scott Wilson
- Department of Renal MedicineAlfred HealthMelbourneVic.Australia
- Department of MedicineMonash UniversityMelbourneVic.Australia
- Department of MedicineEpworth HealthCareMelbourneVic.Australia
| | - Alan Pham
- Department of Anatomical PathologyAlfred HealthMelbourneVic.Australia
| | - Anastasia Chrysostomou
- Department of MedicineMonash UniversityMelbourneVic.Australia
- Department of MedicineEpworth HealthCareMelbourneVic.Australia
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Heron JE, Bagnis CI, Gracey DM. Contemporary issues and new challenges in chronic kidney disease amongst people living with HIV. AIDS Res Ther 2020; 17:11. [PMID: 32178687 PMCID: PMC7075008 DOI: 10.1186/s12981-020-00266-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/22/2020] [Indexed: 12/27/2022] Open
Abstract
Chronic kidney disease (CKD) is a comorbidity of major clinical significance amongst people living with HIV (PLWHIV) and is associated with significant morbidity and mortality. The prevalence of CKD is rising, despite the widespread use of antiretroviral therapy (ART) and is increasingly related to prevalent non-infectious comorbidities (NICMs) and antiretroviral toxicity. There are great disparities evident, with the highest prevalence of CKD among PLWHIV seen in the African continent. The aetiology of kidney disease amongst PLWHIV includes HIV-related diseases, such as classic HIV-associated nephropathy or immune complex disease, CKD related to NICMs and CKD from antiretroviral toxicity. CKD, once established, is often relentlessly progressive and can lead to end-stage renal disease (ESRD). Identifying patients with risk factors for CKD, and appropriate screening for the early detection of CKD are vital to improve patient outcomes. Adherence to screening guidelines is variable, and often poor. The progression of CKD may be slowed with certain clinical interventions; however, data derived from studies involving PLWHIV with CKD are sparse and this represent an important area for future research. The control of blood pressure using angiotensin converting enzyme inhibitors and angiotensin receptor blockers, in particular, in the setting of proteinuria, likely slows the progression of CKD among PLWHIV. The cohort of PLWHIV is facing new challenges in regards to polypharmacy, drug-drug interactions and adverse drug reactions. The potential nephrotoxicity of ART is important, particularly as cumulative ART exposure increases as the cohort of PLWHIV ages. The number of PLWHIV with ESRD is increasing. PLWHIV should not be denied access to renal replacement therapy, either dialysis or kidney transplantation, based on their HIV status. Kidney transplantation amongst PLWHIV is successful and associated with an improved prognosis compared to remaining on dialysis. As the cohort of PLWHIV ages, comorbidity increases and CKD becomes more prevalent; models of care need to evolve to meet the new and changing chronic healthcare needs of these patients.
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Affiliation(s)
- Jack Edward Heron
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Corinne Isnard Bagnis
- Nephrology Department, Groupe Hospitalier Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - David M Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
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The spectrum of kidney biopsy findings in HIV-infected patients in the modern era. Kidney Int 2020; 97:1006-1016. [PMID: 32278618 DOI: 10.1016/j.kint.2020.01.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/27/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
HIV-associated kidney disease is evolving rapidly. Few North American studies have addressed modern trends and none has applied the 2018 Kidney Disease Improving Global Outcomes (KDIGO) pathologic classification. Therefore we performed a retrospective clinical-pathologic analysis of all HIV-positive patients with kidney biopsy interpreted at Columbia University from 2010-2018 using the KDIGO classification. The biopsy cohort of 437 HIV-positive patients had median age 53 years, including 66% males, 80% on anti-retroviral therapy, 57% with hypertension, 31% with diabetes, 27% with hepatitis C and 6% with hepatitis B co-infections. Race, known in 308 patients, included 58% black, 25% white and 17% Hispanic. Pathologic diagnoses were surprisingly diverse. Immune complex glomerulonephritis (ICGN) and diabetic nephropathy each outnumbered HIV-associated nephropathy, followed by tenofovir nephrotoxicity, FSGS- not otherwise specified (NOS) and global sclerosis (NOS). HIV-associated nephropathy was the most common disease in patients not on anti-retroviral therapy, and 94% were black. The association of FSGS (NOS) with black race (68%) and anti-retroviral therapy use (77%) suggests some cases may represent attenuated HIV-associated nephropathy. The most common ICGNs were IgA nephropathy and membranous glomerulopathy, both associating with anti-retroviral therapy (over 90%), followed by hepatitis C-associated proliferative ICGN. Among the 16 cases of uncharacterized ICGN lacking identifiable etiology, 69% were not on anti-retroviral therapy, possibly representing true HIV-associated immune complex kidney disease. Dual diseases occurred in 17% of patients, underscoring lesion complexity. Thus, anti-retroviral therapy has shifted the landscape of HIV-associated kidney disease toward diverse ICGN, diabetic nephropathy, and non-collapsing glomerulosclerosis, but has not eradicated HIV-associated nephropathy.
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Kawakita C, Kinomura M, Otaka N, Kitagawa M, Sugiyama H, Kusano N, Mizuno M, Wada J. HIV-associated Immune Complex Kidney Disease with C3-dominant Deposition Induced by HIV Infection after Treatment of IgA Nephropathy. Intern Med 2019; 58:3001-3007. [PMID: 31243235 PMCID: PMC6859386 DOI: 10.2169/internalmedicine.2439-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 57-year-old man was diagnosed with IgA nephropathy. Hematuria and proteinuria were improved by tonsillectomy plus methylprednisolone pulse therapy. Lymphadenopathy, hypocomplementemia and pancytopenia were observed six years later, and urinalysis abnormalities recurred. A biopsy revealed mesangial proliferative glomerulonephritis with C3-dominant deposition. Human immunodeficiency virus (HIV) antibody demonstrated positive conversion. He was diagnosed with HIV-associated immune complex kidney disease (HIVICK). The hematuria, proteinuria and hypocomplementemia were improved by reducing the HIV viral load through antiretroviral therapy. When C3-dominant deposition is observed on a renal biopsy, HIVICK must be differentiated.
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Affiliation(s)
- Chieko Kawakita
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Masaru Kinomura
- Division of Hemodialysis and Apheresis, Okayama University Hospital, Japan
| | - Nozomu Otaka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Masashi Kitagawa
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Nobuchika Kusano
- Department of Infectious Diseases, Okayama University Hospital, Japan
| | - Masashi Mizuno
- Renal Replacement Therapy, Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Pontes PS, Melo ES, Costa CRB, Antonini M, Sousa LRM, Gir E, Reis RK. Estimativa da taxa de filtração glomerular em pessoas vivendo com HIV. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Avaliar os fatores associados à estimativa da Taxa de Filtração Glomerular (eTFG) em pessoas vivendo com HIV. Métodos Estudo transversal e analítico, com avaliação de 340 pessoas em atendimento ambulatorial no município de Ribeirão Preto-SP. Calculou-se a eTFG através da fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Foi realizado análise univariada com os testes Qui-quadrado e Exato de Fisher, com p<0,05. Resultados Identificou que 114 (34,1%) dos participantes apresentaram alterações na Filtração Glomerular, dos quais (90) 27,5% foram classificadas em estágio 2, 15 (4,5%) em estágio 3A e 07 (2,1%) em estágio 3B. Conclusão O estudo evidenciou que as variáveis sexo, idade, hipertensão, diabetes, IMC e tempo de diagnóstico apresentaram associação com a Taxa de Filtração Glomerular. Ressalta-se a importância do acompanhamento integral de PVHIV para a tomada de decisões de modo a prevenir a ocorrência de disfunções renais.
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Jose S, Hamzah L, Jones R, Williams D, Winston A, Burns F, Phillips AN, Sabin CA, Post FA. Chronic Kidney Disease Risk in African and Caribbean Populations With HIV. J Infect Dis 2019; 218:1767-1772. [PMID: 29982487 PMCID: PMC6195659 DOI: 10.1093/infdis/jiy397] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/04/2018] [Indexed: 11/12/2022] Open
Abstract
We conducted an observational cohort study of end-stage kidney disease (ESKD) in >7000 African and Caribbean people with HIV in the UK. Using Poisson regression and East Africans as the reference group, the adjusted incidence rate ratio (95% confidence interval) of ESKD was 3.14 (1.26–7.84) in Southern Africans, 6.35 (2.53–15.96) in West Africans, and 5.26 (1.91–14.43) in Caribbeans. Higher CD4 cell count and suppressed HIV replication were associated with reduced risk of ESKD. The risk of ESKD varied among HIV-positive people of African heritage, with the highest rates observed in those of West African descent.
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Affiliation(s)
- Sophie Jose
- Institute for Global Health, University College London
| | - Lisa Hamzah
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London
| | - Rachael Jones
- Department of Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Debbie Williams
- Department of Sexual Health, Brighton and Sussex University Hospitals NHS Trust
| | - Alan Winston
- Division of Infectious Diseases, Department of Medicine, Imperial College London, United Kingdom
| | - Fiona Burns
- Institute for Global Health, University College London
| | | | | | - Frank A Post
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London
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Alfano G, Cappelli G, Fontana F, Di Lullo L, Di Iorio B, Bellasi A, Guaraldi G. Kidney Disease in HIV Infection. J Clin Med 2019; 8:jcm8081254. [PMID: 31430930 PMCID: PMC6722524 DOI: 10.3390/jcm8081254] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022] Open
Abstract
Antiretroviral therapy (ART) has significantly improved life expectancy of infected subjects, generating a new epidemiological setting of people aging withHuman Immunodeficiency Virus (HIV). People living with HIV (PLWH), having longer life expectancy, now face several age-related conditions as well as side effects of long-term exposure of ART. Chronic kidney disease (CKD) is a common comorbidity in this population. CKD is a relentlessly progressive disease that may evolve toward end-stage renal disease (ESRD) and significantly affect quality of life and risk of death. Herein, we review current understanding of renal involvement in PLWH, mechanisms and risk factors for CKD as well as strategies for early recognition of renal dysfunction and best care of CKD.
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Affiliation(s)
- Gaetano Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41125 Modena, Italy.
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41125 Modena, Italy.
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Francesco Fontana
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, "L. Parodi-Delfino" Hospital, 00034 Colleferro, Italy
| | - Biagio Di Iorio
- Department of Medicine, AORN "Antonio Cardarelli", 80131 Naples, Italy
| | - Antonio Bellasi
- Department of Research, Innovation, Brand Reputation, Ospedale di Bergamo, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy
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Halle MP, Essomba N, Djantio H, Tsele G, Fouda H, Luma NH, Ashuntantang EG, Kaze FF. Clinical characteristics and outcome of HIV infected patients with chronic kidney disease in Sub Saharan Africa: an example from in Cameroon. BMC Nephrol 2019; 20:253. [PMID: 31288761 PMCID: PMC6617860 DOI: 10.1186/s12882-019-1446-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 07/01/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is one of the major complications of Human immune deficiency Virus (HIV) and a risk factor for poor outcome of these patients. We aimed to describe the profile and outcome of HIV positive patients with CKD in Douala general hospital in Cameroon. METHODS HIV positive patients with CKD referred to the nephrologist from January 2007 to March 2013 were included. Socio demographic, clinical (history and stage of HIV, comorbidities, baseline nephropathy, used of c-ART), para clinical data at referral (serum urea, creatinine, full blood count, CD4 count, serum calcium, phosphorus, albumin), dialysis initiation and outcome at 1 year were collected from medical records. GFR was estimated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. CKD was defined and classified according to the Kidney Disease Improving Global Outcomes (KDIGO 2012). RESULTS We included 156 patients (51.3% men) with a mean age of 45.4 ± 12.1 years. Hypertension (36.5%), diabetes (17.9%) and Hepatitis C (7.7%) were the main comorbidities. HIV associated nephropathy (27.6%), chronic glomerulonephritis (15.4%) diabetes (14.1%) and hypertension (13.5%) were the leading causes of kidney disease. Before referral HIV status was known by 109 (69.9%) patients, with 76 (69.7%) being on c-ART. Median CD4 count was 241 (117-438) cells/mm3. Prevalence of anemia (93.9%), hypocalcemia (68.6%) and Proteinuria (77.6%) was high, 94 (60.3%) patients were at CKD stage 5 at referral and 37 (23.7%) underwent emergency dialysis. After 1 year, 64 (41.0%) patients were lost to follow up. The mortality rate was 49% and 25 (28.7%) were maintenance hemodialysis, and being on c-ART was associated with a lower risk of death (HR: 0.45; 95% CI: 0.23-0.89; p = 0.021). CONCLUSION HIV patients with CKD were referred late with high morbidity and need for urgent hemodialysis. HIVAN was the main etiology of CKD and mortality rate was high mainly due to the absence of c-ART at referral.
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Affiliation(s)
- Marie Patrice Halle
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Department of Internal Medicine, Douala General Hospital, PO Box: 4856, Douala, Cameroon
| | - Noel Essomba
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Hilaire Djantio
- Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon
| | - Germaine Tsele
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Hermine Fouda
- Department of Internal Medicine, Douala General Hospital, PO Box: 4856, Douala, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Namme Henri Luma
- Department of Internal Medicine, Douala General Hospital, PO Box: 4856, Douala, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Enow Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Internal Medicine, Yaounde General Hospital, Yaoundé, Cameroon
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Abstract
OBJECTIVE To describe the spectrum of kidney disease in African patients with HIV and tuberculosis (TB). METHODS We used data from three cohorts: consecutive patients with HIV/TB in South London (UK, 2004-2016; n = 95), consecutive patients with HIV/TB who underwent kidney biopsy in Cape Town (South Africa, 2014-2017; n = 70), and consecutive patients found to have HIV/TB on autopsy in Abidjan (Cote d'Ivoire, 1991; n = 100). Acute kidney injury (AKI) was ascertained using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. In the Cape Town cohort, predictors of recovery of kidney function at 6 months were assessed using Cox regression. RESULTS In the London cohort, the incidence of moderate/severe AKI at 12 months was 15.1 (95% CI 8.6-26.5) per 100 person-years, and the prevalence of chronic and end-stage kidney disease (ESKD) 13.7 and 5.7%, respectively. HIV-associated nephropathy (HIVAN) was diagnosed in 6% of patients in London, and in 6% of autopsy cases in Abidjan. Evidence of renal TB was present in 60% of autopsies in Abidjan and 61% of kidney biopsies in Cape Town. HIVAN and acute tubular necrosis (ATN) were also common biopsy findings in Cape Town. In Cape Town, 40 patients were dialyzed, of whom 28 (70%) were able to successfully discontinue renal replacement therapy. Antiretroviral therapy status, CD4 cell count, estimated glomerular filtration rate (eGFR) at biopsy and renal histology, other than ATN, were not predictive of eGFR recovery. CONCLUSION Kidney disease was common in Africans with HIV/TB. Monitoring of kidney function, and provision of acute dialysis to those with severe kidney failure, is warranted.
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Sury K, Perazella MA. The Changing Face of Human Immunodeficiency Virus-Mediated Kidney Disease. Adv Chronic Kidney Dis 2019; 26:185-197. [PMID: 31202391 DOI: 10.1053/j.ackd.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 01/09/2023]
Abstract
In nearly 40 years since human immunodeficiency virus (HIV) first emerged, much has changed. Our understanding of the pathogenesis of HIV infection and its effect on the cells within each kidney compartment has progressed, and the natural history of the disease has been transformed. What was once an acutely fatal illness is now a chronic disease managed with oral medications. This change is largely due to the advent of antiretroviral drugs, which have dramatically altered the prognosis and progression of HIV infection. However, the success of antiretroviral therapy has brought with it new challenges for the nephrologist caring for patients with HIV/acquired immune deficiency syndrome, including antiretroviral therapy-induced nephrotoxicity, development of non-HIV chronic kidney disease, and rising incidence of immune-mediated kidney injury. In this review, we discuss the pathogenesis of HIV infection and how it causes pathologic changes in the kidney, review the nephrotoxic effects of select antiretroviral medications, and touch upon other causes of kidney injury in HIV cases, including mechanisms of acute kidney injury, HIV-related immune complex glomerular disease, and thrombotic microangiopathy.
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Abstract
PURPOSE OF REVIEW Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) was identified as the major renal manifestation of HIV infection early in the HIV epidemic. However, HIV infection now is associated with a different spectrum of renal lesions leading to chronic kidney disease. This review examines the changes in kidney injury occurring in the current HIV era and the factors involved in this transformation of disease expression. RECENT FINDINGS The incidence of HIVAN and opportunistic infections in HIV-infected individuals has declined in concert with the use of effective combination antiretroviral agents. Chronic kidney disease has become more prevalent as patients infected with HIV are living longer and developing non-HIV-associated diseases such as hypertension and diabetes. Additionally, noncollapsing focal and segmental glomerulosclerosis, co-infection with hepatitis C, HIV-associated immune complex kidney disease, HIV-related accelerated aging, and antiretroviral therapies contribute to progressive loss of renal function. SUMMARY HIV infection is now associated with a variety of renal lesions causing chronic kidney disease, not all of which are virally induced. It is important to determine the cause of renal functional decline in an HIV-infected patient, as this will impact patient management and prognosis.
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Immunological Renal Diseases. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gameiro J, Agapito Fonseca J, Jorge S, Lopes JA. Acute kidney injury in HIV-infected patients: a critical review. HIV Med 2018; 20:77-87. [PMID: 30411475 DOI: 10.1111/hiv.12685] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 12/20/2022]
Abstract
Acute kidney injury (AKI) is characterized by a rapid decline of renal function associated with worse outcomes. The purpose of the authors is to perform a critical review of the incidence, risk factors, pathogenesis and outcome of AKI in HIV-infected patients. Human immunodeficiency virus (HIV)-infected patients have an increased risk of developing AKI, to which contribute both HIV-dependent and HIV-independent factors as well as the nephrotoxicity of drugs used. The increased risk of AKI in HIV-infected patients and its negative impact on prognosis highlights the need for identification of patients at risk, creation of prevention strategies and management. HIV-infected patients have an increased risk of developing AKI, to which both HIV-dependent and HIV-independent factors contribute, as well as the nephrotoxicity of drugs used. The increased risk of AKI in HIV-infected patients and its negative impact on prognosis highlight the need for identification of patients at risk, creation of prevention strategies and management.
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Affiliation(s)
- J Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - J Agapito Fonseca
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - S Jorge
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - J A Lopes
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
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36
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Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2018; 93:545-559. [PMID: 29398134 DOI: 10.1016/j.kint.2017.11.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 12/12/2022]
Abstract
HIV-positive individuals are at increased risk for kidney disease, including HIV-associated nephropathy, noncollapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, as well as kidney injury resulting from prolonged exposure to antiretroviral therapy or from opportunistic infections. Clinical guidelines for kidney disease prevention and treatment in HIV-positive individuals are largely extrapolated from studies in the general population, and do not fully incorporate existing knowledge of the unique HIV-related pathways and genetic factors that contribute to the risk of kidney disease in this population. We convened an international panel of experts in nephrology, renal pathology, and infectious diseases to define the pathology of kidney disease in the setting of HIV infection; describe the role of genetics in the natural history, diagnosis, and treatment of kidney disease in HIV-positive individuals; characterize the renal risk-benefit of antiretroviral therapy for HIV treatment and prevention; and define best practices for the prevention and management of kidney disease in HIV-positive individuals.
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37
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Abstract
The presence of human immunodeficiency virus (HIV)-related kidney disease is an important cause of mortality and morbidity. HIV infection induces renal injury by direct cytotoxicity or immune complex-mediated glomerulonephritis in patients with genetic susceptibility factors. In the last decades, with the development and diffusion of combination antiretroviral therapy, which has prolonged patient survival, there has been a shift in the spectrum of renal diseases in HIV-infected patients, with the decrease of glomerular diseases and increase in the role of nephrotoxicity and co-morbidities. This review provides a contemporary and critical review on the main renal syndromes occurring in HIV-infected patients.
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Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Sofia Jorge
- Division of Nephrology and Renal Transplantation, Department of Medicine Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - José A Lopes
- Division of Nephrology and Renal Transplantation, Department of Medicine Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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Husain NE, Ahmed MH, Almobarak AO, Noor SK, Elmadhoun WM, Awadalla H, Woodward CL, Mital D. HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention. J Clin Med Res 2018; 10:1-8. [PMID: 29238427 PMCID: PMC5722038 DOI: 10.14740/jocmr3235w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/06/2017] [Indexed: 01/28/2023] Open
Abstract
The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "HIVAN" and "pathology and clinical presentation", in addition to "prevalence and risk factors for HIVAN", with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/µL. Other clinical presentations in African populations include acute kidney injury (AKI), nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN.
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Affiliation(s)
- Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Ahmed O. Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Sufian K. Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Wadie M. Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Clare L. Woodward
- Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Dushyant Mital
- Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
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Cohen SD, Kopp JB, Kimmel PL. Kidney Diseases Associated with Human Immunodeficiency Virus Infection. N Engl J Med 2017; 377:2363-2374. [PMID: 29236630 DOI: 10.1056/nejmra1508467] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Scott D Cohen
- From the Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC (S.D.C., P.L.K.); and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K., P.L.K.)
| | - Jeffrey B Kopp
- From the Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC (S.D.C., P.L.K.); and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K., P.L.K.)
| | - Paul L Kimmel
- From the Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC (S.D.C., P.L.K.); and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K., P.L.K.)
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40
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Kooij KW, Vogt L, Wit FWNM, van der Valk M, van Zoest RA, Goorhuis A, Prins M, Post FA, Reiss P. Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls. J Infect Dis 2017; 216:622-631. [PMID: 28934420 DOI: 10.1093/infdis/jix202] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/07/2017] [Indexed: 01/22/2023] Open
Abstract
Background Human immunodeficiency virus (HIV)-infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute. Methods We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2), albuminuria (albumin/creatinine ratio ≥3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93μg/mmol and/or fractional phosphate excretion >20% with plasma phosphate <0.8 mmol/L) in 596 HIV-infected and 544 HIV-uninfected AGEhIV Cohort Study participants. We also assessed whether being HIV-infected on cART, with follow-up censored when cART regimen was modified, was associated with greater eGFR decline or worsening albuminuria (increase ≥10%/year with change in albuminuria category). Results Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0-4.4), albuminuria (aOR = 5.8; 95% CI = 3.7-9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9-10.2]). Among 377 HIV-infected and 479 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (-0.56; 95% CI = -0.87 to -0.24 mL/min/1.73m2/year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3-4.0). Conclusions In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus-infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.
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Affiliation(s)
- Katherine W Kooij
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Liffert Vogt
- Department of Nephrology, Academic Medical Center
| | - Ferdinand W N M Wit
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development.,Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center.,HIV Monitoring Foundation
| | - Marc van der Valk
- Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center
| | - Rosan A van Zoest
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Abraham Goorhuis
- Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center
| | - Maria Prins
- Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center.,Public Health Service Amsterdam, Infectious Diseases Research, Amsterdam, the Netherlands
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter Reiss
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development.,Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center.,HIV Monitoring Foundation
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Abstract
Viruses are capable of inducing a wide spectrum of glomerular disorders that can be categorized on the basis of the duration of active viremia: acute, subacute, or chronic. The variable responses of the adaptive immune system to each time period of viral infection results mechanistically in different histologic forms of glomerular injury. The unique presence of a chronic viremic carrier state with either hepatitis C (HCV) or HIV has led to the opportunity to study in detail various pathogenic mechanisms of viral-induced glomerular injury, including direct viral infection of renal tissue and the development of circulating immune complexes composed of viral antigens that deposit along the glomerular basement membrane. Epidemiologic data show that approximately 25%-30% of all HIV patients are coinfected with HCV and 5%-10% of all HCV patients are coinfected with HIV. This situation can often lead to a challenging differential diagnosis when glomerular disease occurs in this dual-infected population and requires the clinician to be familiar with the clinical presentation, laboratory workup, and pathophysiology behind the development of renal disease for both HCV and HIV. Both of these viruses can be categorized under the new classification of infection-associated GN as opposed to being listed as causes of postinfectious GN as has previously been applied to them. Neither of these viruses lead to renal injury after a latent period of controlled and inactive viremia. The geneses of HCV- and HIV-associated glomerular diseases share a total dependence on the presence of active viral replication to sustain renal injury so the renal disease cannot be listed under "postinfectious" GN. With the new availability of direct-acting antivirals for HCV and more effective combined antiretroviral therapy for HIV, successful remission and even regression of glomerular lesions can be achieved if initiated at an early stage.
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Affiliation(s)
- Warren L Kupin
- Division of Nephrology, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida
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Hara M, Momoki K, Ubukata M, Ohta A, Tonooka A, Ando M. The renal pathological findings in Japanese HIV-infected individuals with CKD: a clinical case series from a single center. Clin Exp Nephrol 2017; 22:68-77. [PMID: 28597149 DOI: 10.1007/s10157-017-1425-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/31/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic kidney diseases (CKD) have emerged as a significant cause of morbidity and mortality in patients infected with human immunodeficiency virus (HIV). However, the detailed study of renal pathological findings currently remains unclear in these Japanese patients. METHODS A retrospective cohort study was undertaken to investigate renal pathological findings between January 1996 and July 2016. Our study included 20 Japanese HIV-infected patients with CKD; 10 cases had undergone renal biopsies, and 10 cases had undergone autopsies, respectively. Moreover, in the 10 biopsied patients, their clinical courses as well as renal outcomes after renal biopsy were also reviewed. RESULTS All of the patients had received combination antiretroviral therapy (cART). The 10 biopsy cases (mean age, 54 ± 14 years and duration of cART, 8 ± 5 years) included three cases of diabetic nephropathy (DMN), two of IgA nephropathy, two of cART-induced tubulointerstitial nephritis (TIN), one of minimal change disease, one case of only finding intrarenal arterioles, and one case without abnormal findings. Among those patients, their clinical courses were preferable except for in the DMN cases. In the autopsy cases (mean age, 52 ± 10 years and duration of cART, 5 ± 5 years), no distinct mesangial or membranous abnormalities were detected. Mild to moderate tubulointerstitial atrophies were observed in six cases. Intrarenal arteriosclerosis was identified in nine cases, and the proportion of global glomerulosclerosis seen was 8.4 ± 12.5%/100 glomeruli. CONCLUSION DMN and cART-induced TIN was noted in the biopsy cases. In the autopsy cases, renal arteriosclerosis, global glomerulosclerosis, and tubulointerstitial atrophy were remarkable. Early diagnosis of kidney diseases should be crucial to introduce optimal management, including controlling rigorous comorbidities and appropriate use of cART, to prevent further progression of CKD.
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Affiliation(s)
- Masaki Hara
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan.
| | - Kumiko Momoki
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
| | - Masamitsu Ubukata
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
| | - Akihito Ohta
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
| | - Akiko Tonooka
- Division of Pathology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Minoru Ando
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
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Hamzah L, Jose S, Booth JW, Hegazi A, Rayment M, Bailey A, Williams DI, Hendry BM, Hay P, Jones R, Levy JB, Chadwick DR, Johnson M, Sabin CA, Post FA. Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate. J Infect 2017; 74:492-500. [PMID: 28130143 DOI: 10.1016/j.jinf.2017.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/07/2016] [Accepted: 01/17/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Tenofovir disoproxil fumarate (TDF) is widely used in the treatment or prevention of HIV and hepatitis B infection. TDF may cause renal tubulopathy in a small proportion of recipients. We aimed to study the risk factors for developing severe renal tubulopathy. METHODS We conducted an observational cohort study with retrospective identification of cases of treatment-limiting tubulopathy during TDF exposure. We used multivariate Poisson regression analysis to identify risk factors for tubulopathy, and mixed effects models to analyse adjusted estimated glomerular filtration rate (eGFR) slopes. RESULTS Between October 2002 and June 2013, 60 (0.4%) of 15,983 patients who had received TDF developed tubulopathy after a median exposure of 44.1 (IQR 20.4, 64.4) months. Tubulopathy cases were predominantly male (92%), of white ethnicity (93%), and exposed to antiretroviral regimens that contained boosted protease inhibitors (PI, 90%). In multivariate analysis, age, ethnicity, CD4 cell count and use of didanosine or PI were significantly associated with tubulopathy. Tubulopathy cases experienced significantly greater eGFR decline while receiving TDF than the comparator group (-6.60 [-7.70, -5.50] vs. -0.34 [-0.43, -0.26] mL/min/1.73 m2/year, p < 0.0001). CONCLUSIONS Older age, white ethnicity, immunodeficiency and co-administration of ddI and PI were risk factors for tubulopathy in patients who received TDF-containing antiretroviral therapy. The presence of rapid eGFR decline identified TDF recipients at increased risk of tubulopathy.
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Affiliation(s)
- L Hamzah
- Kings College Hospital NHS Foundation Trust, London, UK; King's College London, London, UK.
| | - S Jose
- University College London, London, UK
| | - J W Booth
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - A Hegazi
- St George's Healthcare NHS Trust, London, UK
| | - M Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Bailey
- Imperial College Healthcare NHS Trust, London, UK
| | - D I Williams
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | - P Hay
- St George's Healthcare NHS Trust, London, UK
| | - R Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - J B Levy
- Imperial College Healthcare NHS Trust, London, UK
| | - D R Chadwick
- South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - M Johnson
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - C A Sabin
- University College London, London, UK
| | - F A Post
- Kings College Hospital NHS Foundation Trust, London, UK
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Campos P, Ortiz A, Soto K. HIV and kidney diseases: 35 years of history and consequences. Clin Kidney J 2016; 9:772-781. [PMID: 27994853 PMCID: PMC5162418 DOI: 10.1093/ckj/sfw104] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/15/2016] [Indexed: 01/08/2023] Open
Abstract
Kidney diseases in human immunodeficiency virus (HIV)-infected patients are often misdiagnosed. Despite reductions in morbidity and mortality owing to widespread use of highly effective combination antiretroviral therapy (cART), acute kidney injury (AKI) and chronic kidney disease (CKD) are still more common in these patients than in the general population, and are associated with poor health outcomes. HIV-associated nephropathy and HIV immune complex kidney diseases are the more recognizable HIV-related kidney diseases. However, a broad spectrum of kidney disorders related or not directly related with HIV infection can be observed, including cART-induced AKI, CKD, proximal tubular dysfunction, crystalluria and urolithiasis, among others. This review summarizes the major epidemiologic studies of kidney diseases in HIV-infected patients, discusses novel approaches that may potentially limit nephrotoxicity such as the use of tenofovir alafenamide, and outlines current screening measures for early diagnosis of kidney dysfunction or tubular damage, and for accurate detection of increased risk for acute or chronic kidney diseases.
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Affiliation(s)
- Pedro Campos
- Nephrology Department, Hospital Fernando Fonseca, Lisbon, Portugal
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, School of Medicine, UAM and IRSIN, Madrid, Spain; Iberoamerican CKD Research Network (IBERERC), Madrid, Spain
| | - Karina Soto
- Nephrology Department, Hospital Fernando Fonseca, Lisbon, Portugal; Iberoamerican CKD Research Network (IBERERC), Madrid, Spain; Chronic Diseases Research Center-CEDOC-FCM, Nova Medical School, Lisbon, Lisbon, Portugal
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45
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Diana NE, Naicker S. Update on current management of chronic kidney disease in patients with HIV infection. Int J Nephrol Renovasc Dis 2016; 9:223-234. [PMID: 27695357 PMCID: PMC5033612 DOI: 10.2147/ijnrd.s93887] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN). However, the prevalence of end-stage renal disease in HIV-positive individuals has risen, mainly due to increased longevity on cART. There is a disparity in the occurrence of HIVAN among HIV-positive individuals such that there is an 18- to 50-fold increased risk of developing kidney disease among HIV-positive individuals of African descent aged between 20 and 64 years and who have a poorer prognosis compared with their European descent counterparts, suggesting that genetic factors play a vital role. Other risk factors include male sex, low CD4 counts, and high viral load. Improvement in renal function has been observed after initiation of cART in patients with HIV-associated CKD. Treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker is recommended, when clinically indicated in patients with confirmed or suspected HIVAN or clinically significant albuminuria. Other standard management approaches for patients with CKD are recommended. These include addressing other cardiovascular risk factors (appropriate use of statins and aspirin, weight loss, cessation of smoking), avoidance of nephrotoxins, and management of serum bicarbonate and uric acid, anemia, calcium, and phosphate abnormalities. Early diagnosis of kidney disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended.
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Affiliation(s)
- Nina E Diana
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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