HIV-associated nephropathy: clinical characteristics and therapeutic options

HIV-associated nephropathy is a unique form of renal disease specific to HIV infection. Proteinuria and rapidly worsening azotemia in the absence of edema and hypertension are characteristic. Renal biopsy reveals collapsing and/or sclerotic glomeruli, microcystic tubular dilatation, and cellular interstitial infiltrates. Direct cytopathic effects of HIV in the setting of a particular cytokine milieu appears to be the mechanism responsible for the renal injury. There is limited therapeutic experience, but trials with steroids and angiotensin-converting enzyme inhibitors are encouraging. Dialysis is the main form of renal replacement therapy. Better understanding of the disease should improve treatment and prognosis.